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Karvelas N, Oh B, Wang E, Cobigo Y, Tsuei T, Fitzsimons S, Younes K, Ehrenberg A, Geschwind MD, Schwartz D, Kramer JH, Ferguson AR, Miller BL, Silbert LC, Rosen HJ, Elahi FM. Enlarged perivascular spaces are associated with white matter injury, cognition and inflammation in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Brain Commun 2024; 6:fcae071. [PMID: 38495305 PMCID: PMC10943571 DOI: 10.1093/braincomms/fcae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/18/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
Enlarged perivascular spaces have been previously reported in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, but their significance and pathophysiology remains unclear. We investigated associations of white matter enlarged perivascular spaces with classical imaging measures, cognitive measures and plasma proteins to better understand what enlarged perivascular spaces represent in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and whether radiographic measures of enlarged perivascular spaces would be of value in future therapeutic discovery studies for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Twenty-four individuals with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and 24 age- and sex-matched controls were included. Disease status was determined based on the presence of NOTCH3 mutation. Brain imaging measures of white matter hyperintensity, brain parenchymal fraction, white matter enlarged perivascular space volumes, clinical and cognitive measures as well as plasma proteomics were used in models. White matter enlarged perivascular space volumes were calculated via a novel, semiautomated pipeline, and levels of 7363 proteins were quantified in plasma using the SomaScan assay. The relationship of enlarged perivascular spaces with global burden of white matter hyperintensity, brain atrophy, functional status, neurocognitive measures and plasma proteins was modelled with linear regression models. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and control groups did not exhibit differences in mean enlarged perivascular space volumes. However, increased enlarged perivascular space volumes in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy were associated with increased white matter hyperintensity volume (β = 0.57, P = 0.05), Clinical Dementia Rating Sum-of-Boxes score (β = 0.49, P = 0.04) and marginally with decreased brain parenchymal fraction (β = -0.03, P = 0.10). In interaction term models, the interaction term between cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy disease status and enlarged perivascular space volume was associated with increased white matter hyperintensity volume (β = 0.57, P = 0.02), Clinical Dementia Rating Sum-of-Boxes score (β = 0.52, P = 0.02), Mini-Mental State Examination score (β = -1.49, P = 0.03) and marginally with decreased brain parenchymal fraction (β = -0.03, P = 0.07). Proteins positively associated with enlarged perivascular space volumes were found to be related to leukocyte migration and inflammation, while negatively associated proteins were related to lipid metabolism. Two central hub proteins were identified in protein networks associated with enlarged perivascular space volumes: CXC motif chemokine ligand 8/interleukin-8 and C-C motif chemokine ligand 2/monocyte chemoattractant protein 1. The levels of CXC motif chemokine ligand 8/interleukin-8 were also associated with increased white matter hyperintensity volume (β = 42.86, P = 0.03), and levels of C-C motif chemokine ligand 2/monocyte chemoattractant protein 1 were further associated with decreased brain parenchymal fraction (β = -0.0007, P < 0.01) and Mini-Mental State Examination score (β = -0.02, P < 0.01) and increased Trail Making Test B completion time (β = 0.76, P < 0.01). No proteins were associated with all three studied imaging measures of pathology (brain parenchymal fraction, enlarged perivascular spaces, white matter hyperintensity). Based on associations uncovered between enlarged perivascular space volumes and cognitive functions, imaging and plasma proteins, we conclude that white matter enlarged perivascular space volumes may capture pathologies contributing to chronic brain dysfunction and degeneration in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
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Affiliation(s)
- Nikolaos Karvelas
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bradley Oh
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Earnest Wang
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Yann Cobigo
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Torie Tsuei
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Stephen Fitzsimons
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kyan Younes
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94304, USA
| | - Alexander Ehrenberg
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Michael D Geschwind
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Daniel Schwartz
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Adam R Ferguson
- Department of Neurological surgery, Brain and Spinal Injury Center (BASIC), Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94110, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Lisa C Silbert
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, OR 97239, USA
- Portland Veterans Affairs Health Care System, Portland, OR 97239, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
| | - Fanny M Elahi
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA 94158, USA
- James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY 10468, USA
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Zhang R, Chen CH, Tezenas Du Montcel S, Lebenberg J, Cheng YW, Dichgans M, Tang SC, Chabriat H. The CADA-MRIT: An MRI Inventory Tool for Evaluating Cerebral Lesions in CADASIL Across Cohorts. Neurology 2023; 101:e1665-e1677. [PMID: 37652700 PMCID: PMC10624497 DOI: 10.1212/wnl.0000000000207713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most frequent genetic cerebrovascular disease. The clinical aspects of the disease in relation to the various types of lesions on MRI vary widely not only within families but also between different cohorts reported worldwide. Many limitations prevent comparison of imaging data obtained with different scanners and sequences in different patient cohorts. We aimed to develop and validate a simple tool to inventory quickly the key MRI features in CADASIL to compare imaging data across different populations. METHODS The Inventory Tool (CADA-MRIT) was designed by consensus after repeated expert meetings. It consists of 11 imaging items to assess periventricular, deep, and superficial white matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMB), centrum semiovale and basal ganglia dilated perivascular spaces (dPVS), superficial and deep atrophy, large infarcts, and macrobleeds. The reliability, clinical relevance, and time-effectiveness of CADA-MRIT were assessed using data from 3 independent patient cohorts. RESULTS Imaging data from 671 patients with CADASIL (440 from France, 119 from Germany, and 112 from Taiwan) were analyzed. Their mean age was 53.4 ± 12.2 years, 54.5% were women, 56.2% had stroke, and 31.1% had migraine with aura. Any lacune was present in at least 70% of individuals, whereas CMB occurred in 83% of patients from the Asian cohort and in only 35% of European patients. CADA-MRIT scores obtained for WMH, CMB, and dPVS were comparable regardless of the scanner or sequence used (weighted κ > 0.60). Intrarater and interrater agreements were from good to very good (weighted κ > 0.60). Global WMH and atrophy scores correlated strongly with accurate volumetric quantification of WMH or brain parenchymal fraction (Pearson r > 0.60). Different imaging scores were significantly associated with the main clinical manifestations of the disease. The time for evaluating 1 patient was approximately 2-3 minutes. DISCUSSION The CADA-MRIT is an easy-to-use tool for analyzing and comparing the most frequent MRI lesions of CADASIL across different populations. This instrument is reliable. It can be used with different imaging sequences or scanners. It also provides clinically relevant scores in a very short time for completion.
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Affiliation(s)
- Ruiting Zhang
- From the Paris-Cité University (R.Z., J.L., H.C.), Inserm U1141 NeuroDiderot, France; Department of Radiology (R.Z.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology (C.-H.C., Y.-W.C., S.-C.T.), National Taiwan University Hospital, Taipei; Department of Clinical Neurosciences (C.-H.C.), University of Calgary, Alberta, Canada; Sorbonne Université (S.T.D.M.), Paris Brain Institute, INSERM, INRIA, CNRS, APHP; Lariboisière University Hospital (J.L., H.C.), APHP, Translational Neurovascular Centre and Department of Neurology, Reference Center for Rare Vascular Diseases of the Central Nervous System and the Retina (CERVCO), FHU NeuroVasc, Paris, France; Department of Neurology (Y.-W.C.), National Taiwan University Hospital Hsinchu Branch; Institute for Stroke and Dementia Research (M.D.), University Hospital, Ludwig Maximilian University, Munich; German Center for Neurodegenerative Diseases (DZNE) (M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Chih-Hao Chen
- From the Paris-Cité University (R.Z., J.L., H.C.), Inserm U1141 NeuroDiderot, France; Department of Radiology (R.Z.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology (C.-H.C., Y.-W.C., S.-C.T.), National Taiwan University Hospital, Taipei; Department of Clinical Neurosciences (C.-H.C.), University of Calgary, Alberta, Canada; Sorbonne Université (S.T.D.M.), Paris Brain Institute, INSERM, INRIA, CNRS, APHP; Lariboisière University Hospital (J.L., H.C.), APHP, Translational Neurovascular Centre and Department of Neurology, Reference Center for Rare Vascular Diseases of the Central Nervous System and the Retina (CERVCO), FHU NeuroVasc, Paris, France; Department of Neurology (Y.-W.C.), National Taiwan University Hospital Hsinchu Branch; Institute for Stroke and Dementia Research (M.D.), University Hospital, Ludwig Maximilian University, Munich; German Center for Neurodegenerative Diseases (DZNE) (M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Sophie Tezenas Du Montcel
- From the Paris-Cité University (R.Z., J.L., H.C.), Inserm U1141 NeuroDiderot, France; Department of Radiology (R.Z.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology (C.-H.C., Y.-W.C., S.-C.T.), National Taiwan University Hospital, Taipei; Department of Clinical Neurosciences (C.-H.C.), University of Calgary, Alberta, Canada; Sorbonne Université (S.T.D.M.), Paris Brain Institute, INSERM, INRIA, CNRS, APHP; Lariboisière University Hospital (J.L., H.C.), APHP, Translational Neurovascular Centre and Department of Neurology, Reference Center for Rare Vascular Diseases of the Central Nervous System and the Retina (CERVCO), FHU NeuroVasc, Paris, France; Department of Neurology (Y.-W.C.), National Taiwan University Hospital Hsinchu Branch; Institute for Stroke and Dementia Research (M.D.), University Hospital, Ludwig Maximilian University, Munich; German Center for Neurodegenerative Diseases (DZNE) (M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Jessica Lebenberg
- From the Paris-Cité University (R.Z., J.L., H.C.), Inserm U1141 NeuroDiderot, France; Department of Radiology (R.Z.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology (C.-H.C., Y.-W.C., S.-C.T.), National Taiwan University Hospital, Taipei; Department of Clinical Neurosciences (C.-H.C.), University of Calgary, Alberta, Canada; Sorbonne Université (S.T.D.M.), Paris Brain Institute, INSERM, INRIA, CNRS, APHP; Lariboisière University Hospital (J.L., H.C.), APHP, Translational Neurovascular Centre and Department of Neurology, Reference Center for Rare Vascular Diseases of the Central Nervous System and the Retina (CERVCO), FHU NeuroVasc, Paris, France; Department of Neurology (Y.-W.C.), National Taiwan University Hospital Hsinchu Branch; Institute for Stroke and Dementia Research (M.D.), University Hospital, Ludwig Maximilian University, Munich; German Center for Neurodegenerative Diseases (DZNE) (M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Yu-Wen Cheng
- From the Paris-Cité University (R.Z., J.L., H.C.), Inserm U1141 NeuroDiderot, France; Department of Radiology (R.Z.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology (C.-H.C., Y.-W.C., S.-C.T.), National Taiwan University Hospital, Taipei; Department of Clinical Neurosciences (C.-H.C.), University of Calgary, Alberta, Canada; Sorbonne Université (S.T.D.M.), Paris Brain Institute, INSERM, INRIA, CNRS, APHP; Lariboisière University Hospital (J.L., H.C.), APHP, Translational Neurovascular Centre and Department of Neurology, Reference Center for Rare Vascular Diseases of the Central Nervous System and the Retina (CERVCO), FHU NeuroVasc, Paris, France; Department of Neurology (Y.-W.C.), National Taiwan University Hospital Hsinchu Branch; Institute for Stroke and Dementia Research (M.D.), University Hospital, Ludwig Maximilian University, Munich; German Center for Neurodegenerative Diseases (DZNE) (M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Martin Dichgans
- From the Paris-Cité University (R.Z., J.L., H.C.), Inserm U1141 NeuroDiderot, France; Department of Radiology (R.Z.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology (C.-H.C., Y.-W.C., S.-C.T.), National Taiwan University Hospital, Taipei; Department of Clinical Neurosciences (C.-H.C.), University of Calgary, Alberta, Canada; Sorbonne Université (S.T.D.M.), Paris Brain Institute, INSERM, INRIA, CNRS, APHP; Lariboisière University Hospital (J.L., H.C.), APHP, Translational Neurovascular Centre and Department of Neurology, Reference Center for Rare Vascular Diseases of the Central Nervous System and the Retina (CERVCO), FHU NeuroVasc, Paris, France; Department of Neurology (Y.-W.C.), National Taiwan University Hospital Hsinchu Branch; Institute for Stroke and Dementia Research (M.D.), University Hospital, Ludwig Maximilian University, Munich; German Center for Neurodegenerative Diseases (DZNE) (M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Sung-Chun Tang
- From the Paris-Cité University (R.Z., J.L., H.C.), Inserm U1141 NeuroDiderot, France; Department of Radiology (R.Z.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology (C.-H.C., Y.-W.C., S.-C.T.), National Taiwan University Hospital, Taipei; Department of Clinical Neurosciences (C.-H.C.), University of Calgary, Alberta, Canada; Sorbonne Université (S.T.D.M.), Paris Brain Institute, INSERM, INRIA, CNRS, APHP; Lariboisière University Hospital (J.L., H.C.), APHP, Translational Neurovascular Centre and Department of Neurology, Reference Center for Rare Vascular Diseases of the Central Nervous System and the Retina (CERVCO), FHU NeuroVasc, Paris, France; Department of Neurology (Y.-W.C.), National Taiwan University Hospital Hsinchu Branch; Institute for Stroke and Dementia Research (M.D.), University Hospital, Ludwig Maximilian University, Munich; German Center for Neurodegenerative Diseases (DZNE) (M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany
| | - Hugues Chabriat
- From the Paris-Cité University (R.Z., J.L., H.C.), Inserm U1141 NeuroDiderot, France; Department of Radiology (R.Z.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China; Department of Neurology (C.-H.C., Y.-W.C., S.-C.T.), National Taiwan University Hospital, Taipei; Department of Clinical Neurosciences (C.-H.C.), University of Calgary, Alberta, Canada; Sorbonne Université (S.T.D.M.), Paris Brain Institute, INSERM, INRIA, CNRS, APHP; Lariboisière University Hospital (J.L., H.C.), APHP, Translational Neurovascular Centre and Department of Neurology, Reference Center for Rare Vascular Diseases of the Central Nervous System and the Retina (CERVCO), FHU NeuroVasc, Paris, France; Department of Neurology (Y.-W.C.), National Taiwan University Hospital Hsinchu Branch; Institute for Stroke and Dementia Research (M.D.), University Hospital, Ludwig Maximilian University, Munich; German Center for Neurodegenerative Diseases (DZNE) (M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Germany.
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De Lucia N, Ragno M, Paci C, Cacchiò G, Caiazzo AR, Tiberi S, De Rosa A, Navarra R, Caulo M, De Michele G, Trojano L. Constructional Impairments and Their Neural Correlates in Nondemented Adults With Cerebral Autosomal-dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. Cogn Behav Neurol 2022; 35:247-254. [PMID: 36149396 DOI: 10.1097/wnn.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/02/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic small-vessel disease that is characterized by a wide range of neurologic and neuropsychological impairments. Constructional impairments have been reported in some cases but have never been assessed systematically. OBJECTIVE To evaluate constructional abilities and their cognitive and neural correlates in nondemented individuals with CADASIL. METHOD Thirty individuals with CADASIL who were not affected by clinically relevant cognitive deterioration and 30 healthy controls (HC) underwent an extensive cognitive assessment and paper-and-pencil visuoconstructional tasks in order to detect constructional impairments. Performance on the visuoconstructional tasks was correlated with the cognitive assessment scores and with quantitative indices of regional gray matter atrophy (obtained via FreeSurfer image analysis) and white matter involvement. RESULTS The individuals with CADASIL achieved significantly lower scores on the cognitive assessment compared with the HC. Poor visuoconstructional abilities were observed in seven (23.3%) of the individuals with CADASIL when performing the copy drawing task and in nine (30%) when performing the Rey Complex Figure Test. Logistic regression revealed that visuoconstructional impairments were significantly associated with scores on the Frontal Assessment Battery and the Attentional Matrices Test. Morphometric results revealed that scores on the visuoconstructional tasks were related to gray matter atrophy of the left frontal lobe and right parietal lobe. CONCLUSION Impairments on visuoconstructional tasks are quite common in individuals with CADASIL, even in the lack of clinically relevant cognitive deterioration, and are critically related to frontal and parietal atrophy.
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Affiliation(s)
- Natascia De Lucia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico," Naples, Italy
| | - Michele Ragno
- Neurology Division, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Cristina Paci
- Neurology Division, San Benedetto del Tronto, Ascoli Piceno, Italy
| | | | | | - Sara Tiberi
- Neurology Division, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Anna De Rosa
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico," Naples, Italy
| | - Riccardo Navarra
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "D'Annunzio" University of Chiety-Pescara, Chieti, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "D'Annunzio" University of Chiety-Pescara, Chieti, Italy
| | - Giuseppe De Michele
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico," Naples, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
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Dewenter A, Jacob MA, Cai M, Gesierich B, Hager P, Kopczak A, Biel D, Ewers M, Tuladhar AM, de Leeuw FE, Dichgans M, Franzmeier N, Duering M. Disentangling the effects of Alzheimer's and small vessel disease on white matter fibre tracts. Brain 2022; 146:678-689. [PMID: 35859352 PMCID: PMC9924910 DOI: 10.1093/brain/awac265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/30/2022] [Accepted: 06/25/2022] [Indexed: 12/27/2022] Open
Abstract
Alzheimer's disease and cerebral small vessel disease are the two leading causes of cognitive decline and dementia and coexist in most memory clinic patients. White matter damage as assessed by diffusion MRI is a key feature in both Alzheimer's and cerebral small vessel disease. However, disease-specific biomarkers of white matter alterations are missing. Recent advances in diffusion MRI operating on the fixel level (fibre population within a voxel) promise to advance our understanding of disease-related white matter alterations. Fixel-based analysis allows derivation of measures of both white matter microstructure, measured by fibre density, and macrostructure, measured by fibre-bundle cross-section. Here, we evaluated the capacity of these state-of-the-art fixel metrics to disentangle the effects of cerebral small vessel disease and Alzheimer's disease on white matter integrity. We included three independent samples (total n = 387) covering genetically defined cerebral small vessel disease and age-matched controls, the full spectrum of biomarker-confirmed Alzheimer's disease including amyloid- and tau-PET negative controls and a validation sample with presumed mixed pathology. In this cross-sectional analysis, we performed group comparisons between patients and controls and assessed associations between fixel metrics within main white matter tracts and imaging hallmarks of cerebral small vessel disease (white matter hyperintensity volume, lacune and cerebral microbleed count) and Alzheimer's disease (amyloid- and tau-PET), age and a measure of neurodegeneration (brain volume). Our results showed that (i) fibre density was reduced in genetically defined cerebral small vessel disease and strongly associated with cerebral small vessel disease imaging hallmarks; (ii) fibre-bundle cross-section was mainly associated with brain volume; and (iii) both fibre density and fibre-bundle cross-section were reduced in the presence of amyloid, but not further exacerbated by abnormal tau deposition. Fixel metrics were only weakly associated with amyloid- and tau-PET. Taken together, our results in three independent samples suggest that fibre density captures the effect of cerebral small vessel disease, while fibre-bundle cross-section is largely determined by neurodegeneration. The ability of fixel-based imaging markers to capture distinct effects on white matter integrity can propel future applications in the context of precision medicine.
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Affiliation(s)
- Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | - Mina A Jacob
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mengfei Cai
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benno Gesierich
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Paul Hager
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- Institute for AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Anna Kopczak
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | - Davina Biel
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- German Center for Neurodegenerative Disease (DZNE), Munich, Germany
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- German Center for Neurodegenerative Disease (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | | | - Marco Duering
- Correspondence to: Marco Duering Medical Image Analysis Center (MIAC AG) Marktgasse 8 CH-4051 Basel Switzerland E-mail:
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Hack RJ, Cerfontaine MN, Gravesteijn G, Tap S, Hafkemeijer A, van der Grond J, Witjes-Ané MN, Baas F, Rutten JW, Lesnik Oberstein SA. Effect of
NOTCH3
EGFr Group, Sex, and Cardiovascular Risk Factors on CADASIL Clinical and Neuroimaging Outcomes. Stroke 2022; 53:3133-3144. [PMID: 35862191 PMCID: PMC9508953 DOI: 10.1161/strokeaha.122.039325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A retrospective study has shown that EGFr (epidermal growth factor–like repeat) group in the NOTCH3 gene is an important cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) disease modifier of age at first stroke and white matter hyperintensity (WMH) volume. No study has yet assessed the effect of other known CADASIL modifiers, that is, cardiovascular risk factors and sex, in the context of NOTCH3 EGFr group. In this study, we determined the relative disease-modifying effects of NOTCH3 EGFr group, sex and cardiovascular risk factor on disease severity in the first genotype-driven, large prospective CADASIL cohort study, using a comprehensive battery of CADASIL clinical outcomes and neuroimaging markers.
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Affiliation(s)
- Remco J. Hack
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Minne N. Cerfontaine
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Stephan Tap
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Anne Hafkemeijer
- Department of Radiology, Leiden University Medical Center, the Netherlands. (A.H., J.v.d.G.)
- Institute of Psychology, Leiden University, the Netherlands. (A.H.)
- Leiden Institute for Brain and Cognition, Leiden University, the Netherlands. (A.H.)
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, the Netherlands. (A.H., J.v.d.G.)
| | - Marie-Noëlle Witjes-Ané
- Department of Geriatrics and Psychiatrics, Leiden University Medical Center, the Netherlands. (M.N.W.-A.)
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Julie W. Rutten
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Saskia A.J. Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
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6
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Yasuda K, Ayaki T, Li F, Kuwata Y, Maki T, Sainouchi M, Moriyoshi K, Nakamura M, Takahashi R. White matter edematous change with moderate vascular lesions in pretreated acute stage of leukoencephalopathy with cerebral amyloid angiopathy. Neuropathology 2022; 42:134-140. [PMID: 35037303 DOI: 10.1111/neup.12782] [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: 02/01/2021] [Revised: 07/23/2021] [Accepted: 09/14/2021] [Indexed: 12/01/2022]
Abstract
A 79-year-old man presented with subacute onset of dementia. Brain magnetic resonance imaging revealed leukoencephalopathy in the posterior lobes with presence of microbleeds. Although clinical manifestation suggested a diagnosis of leukoencephalopathy associated with cerebral amyloid angiopathy (CAA), the patient died of sudden rupture of an aneurysm of the thoracic aorta two months after the onset of dementia. Autopsy revealed pathological features of advanced-stage Alzheimer's disease. Immunohistochemistry for amyloid-β revealed CAA mainly affecting arteries but not capillaries. Klüver-Barrera staining revealed white matter edema predominantly in the occipital lobes without ischemic changes. Perivascular cuffing was found to be sparse, but there was no evidence of angiitis. Pathological findings suggest that leukoencephalopathy was caused by the disruption of the blood-brain barrier rather than ischemia. Because the present patient died before immunotherapy, his neuropathological findings could reflect the pathomechanism of the acute stage of leukoencephalopathy with CAA.
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Affiliation(s)
- Ken Yasuda
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Ayaki
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fangzhou Li
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, and Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yasuhiro Kuwata
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takakuni Maki
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Makoto Sainouchi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Michikazu Nakamura
- Department of Neurology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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7
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Rastogi A, Weissert R, Bhaskar SMM. Emerging role of white matter lesions in cerebrovascular disease. Eur J Neurosci 2021; 54:5531-5559. [PMID: 34233379 DOI: 10.1111/ejn.15379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/26/2021] [Accepted: 06/26/2021] [Indexed: 12/12/2022]
Abstract
White matter lesions have been implicated in the setting of stroke, dementia, intracerebral haemorrhage, several other cerebrovascular conditions, migraine, various neuroimmunological diseases like multiple sclerosis, disorders of metabolism, mitochondrial diseases and others. While much is understood vis a vis neuroimmunological conditions, our knowledge of the pathophysiology of these lesions, and their role in, and implications to, management of cerebrovascular diseases or stroke, especially in the elderly, are limited. Several clinical assessment tools are available for delineating white matter lesions in clinical practice. However, their incorporation into clinical decision-making and specifically prognosis and management of patients is suboptimal for use in standards of care. This article sought to provide an overview of the current knowledge and recent advances on pathophysiology, as well as clinical and radiological assessment, of white matter lesions with a focus on its development, progression and clinical implications in cerebrovascular diseases. Key indications for clinical practice and recommendations on future areas of research are also discussed. Finally, a conceptual proposal on putative mechanisms underlying pathogenesis of white matter lesions in cerebrovascular disease has been presented. Understanding of pathophysiology of white matter lesions and how they mediate outcomes is important to develop therapeutic strategies.
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Affiliation(s)
- Aarushi Rastogi
- South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, New South Wales, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Robert Weissert
- Department of Neurology, Regensburg University Hospital, University of Regensburg, Regensburg, Germany
| | - Sonu Menachem Maimonides Bhaskar
- South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, New South Wales, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
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8
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Yu X, Yin X, Hong H, Wang S, Jiaerken Y, Zhang F, Pasternak O, Zhang R, Yang L, Lou M, Zhang M, Huang P. Increased extracellular fluid is associated with white matter fiber degeneration in CADASIL: in vivo evidence from diffusion magnetic resonance imaging. Fluids Barriers CNS 2021; 18:29. [PMID: 34193191 PMCID: PMC8247253 DOI: 10.1186/s12987-021-00264-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background White matter hyperintensities (WMHs) are one of the hallmarks of cerebral small vessel disease (CSVD), but the pathological mechanisms underlying WMHs remain unclear. Recent studies suggest that extracellular fluid (ECF) is increased in brain regions with WMHs. It has been hypothesized that ECF accumulation may have detrimental effects on white matter microstructure. To test this hypothesis, we used cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) as a unique CSVD model to investigate the relationships between ECF and fiber microstructural changes in WMHs. Methods Thirty-eight CADASIL patients underwent 3.0 T MRI with multi-model sequences. Parameters of free water (FW) and apparent fiber density (AFD) obtained from diffusion-weighted imaging (b = 0 and 1000 s/mm2) were respectively used to quantify the ECF and fiber density. WMHs were split into four subregions with four levels of FW using quartiles (FWq1 to FWq4) for each participant. We analyzed the relationships between FW and AFD in each subregion of WMHs. Additionally, we tested whether FW of WMHs were associated with other accompanied CSVD imaging markers including lacunes and microbleeds. Results We found an inverse correlation between FW and AFD in WMHs. Subregions of WMHs with high-level of FW (FWq3 and FWq4) were accompanied with decreased AFD and with changes in FW-corrected diffusion tensor imaging parameters. Furthermore, FW was also independently associated with lacunes and microbleeds. Conclusions Our study demonstrated that increased ECF was associated with WM degeneration and the occurrence of lacunes and microbleeds, providing important new insights into the role of ECF in CADASIL pathology. Improving ECF drainage might become a therapeutic strategy in future. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00264-1.
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Affiliation(s)
- Xinfeng Yu
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xinzhen Yin
- Department of Neurology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Hong
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Shuyue Wang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Yeerfan Jiaerken
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruiting Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Linglin Yang
- Department of Psychiatry, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
| | - Peiyu Huang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
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9
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Pan H, Huang Q, Ban S, Du X, Su J, Liu J. Brain structural changes in CADASIL patients: A morphometric magnetic resonance imaging study. Neurosci Lett 2020; 738:135388. [PMID: 32949660 DOI: 10.1016/j.neulet.2020.135388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a subcortical, inherited, cerebral small vessel disease. Several studies have revealed the involvement of specific cortical regions. However, the structural brain alterations and their clinical correlations remain largely undetermined. METHODS We evaluated 22 CADASIL patients and 22 age- and sex-matched healthy controls. We used surface- and voxel-based morphometric data derived from 3.0-T magnetic resonance imaging (MRI) to explore structural changes in gray and white matter. We calculated Pearson correlations between such data and clinical and MRI metrics. RESULTS Compared with controls, CADASIL patients exhibited significantly decreased cortical thickness in the left supramarginal gyrus, superior temporal gyrus, transverse temporal gyrus, insula, lateral orbitofrontal gyrus, isthmus cingulate gyrus and precentral gyrus. An extensive decrease in the white (but not gray) matter volume was also evident, predominantly in the frontal, parietal, temporal, and occipital lobes. The number of previous strokes or transient ischemic attacks was negatively associated with the cortical thickness of the left pars opercularis and right posterior cingulate gyrus. CONCLUSION Reductions in cortical thickness and white matter volume were evident in CADASIL patients compared with controls, and higher numbers of strokes and transient ischemic attacks were associated with regional cortical thinning.
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Affiliation(s)
- Hui Pan
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Qi Huang
- PET Center, Huashan Hospital, Fudan University, 518 East Wuzhong Road, Shanghai, 200235, People's Republic of China
| | - Shiyu Ban
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Materials Science, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, People's Republic of China
| | - Xiaoxia Du
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Materials Science, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, People's Republic of China.
| | - Jingjing Su
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| | - Jianren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
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10
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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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11
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De Guio F, Duering M, Fazekas F, De Leeuw FE, Greenberg SM, Pantoni L, Aghetti A, Smith EE, Wardlaw J, Jouvent E. Brain atrophy in cerebral small vessel diseases: Extent, consequences, technical limitations and perspectives: The HARNESS initiative. J Cereb Blood Flow Metab 2020; 40:231-245. [PMID: 31744377 PMCID: PMC7370623 DOI: 10.1177/0271678x19888967] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Brain atrophy is increasingly evaluated in cerebral small vessel diseases. We aim at systematically reviewing the available data regarding its extent, correlates and cognitive consequences. Given that in this context, brain atrophy measures might be biased, the first part of the review focuses on technical aspects. Thereafter, data from the literature are analyzed in light of these potential limitations, to better understand the relationships between brain atrophy and other MRI markers of cerebral small vessel diseases. In the last part, we review the links between brain atrophy and cognitive alterations in patients with cerebral small vessel diseases.
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Affiliation(s)
- François De Guio
- Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), APHP, Lariboisière Hospital, Paris, DHU NeuroVasc, Univ Paris Diderot, and U1141 INSERM, France
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Frank-Erik De Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University, Nijmegen, The Netherlands
| | - Steven M Greenberg
- Department of Neurology, Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Leonardo Pantoni
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Agnès Aghetti
- Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), APHP, Lariboisière Hospital, Paris, DHU NeuroVasc, Univ Paris Diderot, and U1141 INSERM, France
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, Edinburgh Imaging, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Eric Jouvent
- Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), APHP, Lariboisière Hospital, Paris, DHU NeuroVasc, Univ Paris Diderot, and U1141 INSERM, France
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12
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Danchenko IY, Kulesh AA, Drobakha VE, Kanivets IV, Akimova IA, Monak AA. [CADASIL syndrome: differential diagnosis with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:128-136. [PMID: 31934998 DOI: 10.17116/jnevro201911910128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Two cases of clinical and MRI manifestations of genetically verified CADASIL syndrome in female patients under 40 years of age are presented. The primary misinterpretation of clinical data and the neuroimaging results within multiple sclerosis indicates a lack of awareness of radiologists and neurologists about this disease. The article reviewed the current literature on the problems of diagnosis and treatment of CADASIL. The clinical and neuroimaging pattern of the syndrome, the approaches to genetic testing and the basic principles of patient management are considered in detail.
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Affiliation(s)
- I Yu Danchenko
- Perm Regional Clinical Hospital, Perm Multiple Sclerosis Center, Perm, Russia
| | - A A Kulesh
- Vagner Perm State Medical University, Perm, Russia; Perm State Clinical Hospital #4, Perm, Russia
| | - V E Drobakha
- Vagner Perm State Medical University, Perm, Russia; Perm State Clinical Hospital #4, Perm, Russia
| | | | - I A Akimova
- State Medical Genetic Center, Moscow, Russia
| | - A A Monak
- Vagner Perm State Medical University, Perm, Russia
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13
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Jouvent E, Duering M, Chabriat H. Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy: Lessons From Neuroimaging. Stroke 2019; 51:21-28. [PMID: 31752612 DOI: 10.1161/strokeaha.119.024152] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Eric Jouvent
- From the Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), APHP, Lariboisière Hospital, F-75475 Paris, France (E.J., H.C.).,DHU NeuroVasc, University Paris Diderot (E.J., H.C.).,U1141 INSERM, Paris, France (E.J., H.C.)
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (M.D.).,Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.)
| | - Hugues Chabriat
- From the Department of Neurology and Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), APHP, Lariboisière Hospital, F-75475 Paris, France (E.J., H.C.).,DHU NeuroVasc, University Paris Diderot (E.J., H.C.).,U1141 INSERM, Paris, France (E.J., H.C.)
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14
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De Guio F, Germanaud D, Lefèvre J, Fischer C, Mangin JF, Chabriat H, Jouvent E. Alteration of the Cortex Shape as a Proxy of White Matter Swelling in Severe Cerebral Small Vessel Disease. Front Neurol 2019; 10:753. [PMID: 31354616 PMCID: PMC6635831 DOI: 10.3389/fneur.2019.00753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
Abstract
CADASIL is a monogenic small vessel disease characterized by the accumulation of brain tissue lesions of microvascular origin leading to strokes and cognitive deficits. Both cortical and parenchymal alterations have been described using various MRI markers. However, relationships between cortical and subcortical alterations remain largely unexplored. While brain atrophy is a preponderant feature in cerebral small vessel disease, recent results in CADASIL suggest slightly larger brain volumes and increased white matter water content at early stages of the disease by comparison to controls. We hypothesized in this study that increased water content in gyral white matter balances expected brain atrophy. Direct white matter volume computation is challenging in these patients given widespread subcortical alterations. Instead, our approach was that a gyral white matter swelling would translate into a modification of the shape of cortical gyri. Our goal was then to assess the relationship between subcortical lesions and possible alteration of the cortex shape. More specifically, aims of this work were to assess 1) morphometric differences of the cortex shape between CADASIL patients and controls 2) the relationship between the cortex shape and the volume of white matter hyperintensities (WMH), a reflect of white matter alterations. Twenty-one patients at the early stage of the disease and 28 age- and sex-matched controls were included. Cortical surfaces were reconstructed from 3D-T1-weighted images. Folding power assessed from spectral analysis of gyrification and cortical morphometry using curvedness and shape index were computed as proxies of the cortex shape. Influence of segmentation errors were evaluated through the simulation of WMH in controls. As a result, patients had larger folding power and curvedness compared to controls. They also presented lower shape indices both related to sulci and gyri. In patients, the volume of WMH was associated with decreased gyral shape index. These results suggest that the cortex shape of CADASIL patients is different compared to controls and that the enlargement of gyri is related to the extent of white matter alterations. The study of the cortex shape might be another way to evaluate subcortical swelling or atrophy in various neurological disorders.
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Affiliation(s)
- François De Guio
- Université Paris Diderot, UMR-S 1161 INSERM, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité, Paris, France
| | - David Germanaud
- Université de Paris, Inserm, NeuroDiderot, inDev Team, Paris, France.,CEA, NeuroSpin, UNIACT, Gif-sur-Yvette, France.,AP-HP, Hôpital Robert-Debré, Service de Neurologie Pédiatrique et des Maladies métaboliques, Paris, France
| | - Julien Lefèvre
- Institut de Neurosciences de la Timone, CNRS UMR7289, Aix-Marseille University, Marseille, France
| | - Clara Fischer
- UNATI, NeuroSpin, I2BM/DSV, CEA, Paris Saclay University, Paris, France
| | | | - Hugues Chabriat
- Université Paris Diderot, UMR-S 1161 INSERM, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité, Paris, France.,AP-HP, Lariboisière Hospital, Department of Neurology, Paris, France
| | - Eric Jouvent
- Université Paris Diderot, UMR-S 1161 INSERM, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité, Paris, France.,AP-HP, Lariboisière Hospital, Department of Neurology, Paris, France
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15
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Ling Y, De Guio F, Jouvent E, Duering M, Hervé D, Guichard JP, Godin O, Dichgans M, Chabriat H. Clinical correlates of longitudinal MRI changes in CADASIL. J Cereb Blood Flow Metab 2019; 39:1299-1305. [PMID: 29400120 PMCID: PMC6668524 DOI: 10.1177/0271678x18757875] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies showed that various types of cerebral lesions, as assessed on MRI, largely contribute to the clinical severity of CADASIL. However, the clinical impact of longitudinal changes of classical markers of small vessel disease on conventional MRI has been only poorly investigated. One hundred sixty NOTCH3 mutation carriers (mean age ± SD, 49.8 ± 10.9 years) were followed over three years. Validated methods were used to determine the percent brain volume change (PBVC), number of incident lacunes, change of volume of white matter hyperintensities and change of number of cerebral microbleeds. Multivariable logistic regression analyses were performed to assess the independent association between changes of these MRI markers and incident clinical events. Mixed-effect multiple linear regression analyses were used to assess their association with changes of clinical scales. Over a mean period of 3.1 ± 0.2 years, incident lacunes are found independently associated with incident stroke and change of Trail Making Test Part B. PBVC is independently associated with all incident events and clinical scale changes except the modified Rankin Scale at three years. Our results suggest that, on conventional MRI, PBVC and the number of incident lacunes are the most sensitive and independent correlates of clinical worsening over three years in CADASIL.
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Affiliation(s)
- Yifeng Ling
- 1 INSERM, U1161 Paris, France.,2 Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - François De Guio
- 1 INSERM, U1161 Paris, France.,3 Department of Neurology, Groupe Hospitalier Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris (APHP), Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France
| | - Eric Jouvent
- 1 INSERM, U1161 Paris, France.,3 Department of Neurology, Groupe Hospitalier Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris (APHP), Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France
| | - Marco Duering
- 4 Institute for Stroke and Dementia Research, Klinikum der Universitaüt Muünchen, Ludwig-Maximilians-University, Munich, Germany
| | - Dominique Hervé
- 1 INSERM, U1161 Paris, France.,3 Department of Neurology, Groupe Hospitalier Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris (APHP), Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France
| | | | - Ophélia Godin
- 3 Department of Neurology, Groupe Hospitalier Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris (APHP), Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France
| | - Martin Dichgans
- 4 Institute for Stroke and Dementia Research, Klinikum der Universitaüt Muünchen, Ludwig-Maximilians-University, Munich, Germany.,5 Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Hugues Chabriat
- 1 INSERM, U1161 Paris, France.,3 Department of Neurology, Groupe Hospitalier Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris (APHP), Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France
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16
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Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications. Lancet Neurol 2019; 18:684-696. [DOI: 10.1016/s1474-4422(19)30079-1] [Citation(s) in RCA: 500] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 02/06/2023]
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17
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De Guio F, Vignaud A, Chabriat H, Jouvent E. Different types of white matter hyperintensities in CADASIL: Insights from 7-Tesla MRI. J Cereb Blood Flow Metab 2018; 38:1654-1663. [PMID: 28128022 PMCID: PMC6125962 DOI: 10.1177/0271678x17690164] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), by contrast to sporadic cerebral small vessel disease related to age and hypertension, white matter hyperintensities (WMH) are frequently observed in the white matter of anterior temporal poles, external capsules, and superior frontal regions. Whether these WMH (specific WMH) differ from those observed in other white matter areas (nonspecific WMH) remains unknown. Twenty patients were scanned to compare specific and nonspecific WMH using high-resolution images and analyses of relaxation times (T1R: longitudinal relaxation time and T2*R: effective transversal relaxation time). Specific WMH were characterized by significantly longer T1R and T2*R (T1R: 2309 ± 120 ms versus 2145 ± 138 ms; T2*R: 40 ± 5 ms versus 35 ± 5 ms, p < 0.001). These results were not explained by the presence of dilated perivascular spaces found in the close vicinity of specific WMH. They were not either explained by the normal regional variability of T1R and T2*R in the white matter nor by systematic imaging artifacts as shown by the study of 17 age- and sex-matched healthy controls. Our results suggest large differences in water content between specific and nonspecific WMH in CADASIL, supporting that mechanisms underlying WMH may differ according to their location.
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Affiliation(s)
- François De Guio
- 1 University Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France.,2 DHU NeuroVasc Sorbonne Paris Cité, Paris, France
| | | | - Hugues Chabriat
- 1 University Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France.,2 DHU NeuroVasc Sorbonne Paris Cité, Paris, France.,4 AP-PH, Lariboisière Hosp., Department of neurology, F-75475, Paris, France
| | - Eric Jouvent
- 1 University Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, Paris, France.,2 DHU NeuroVasc Sorbonne Paris Cité, Paris, France.,4 AP-PH, Lariboisière Hosp., Department of neurology, F-75475, Paris, France.,5 UNIACT, NeuroSpin, I2BM/DSV, CEA, Gif-sur-Yvette, France
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18
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Wardlaw JM, Chappell FM, Valdés Hernández MDC, Makin SDJ, Staals J, Shuler K, Thrippleton MJ, Armitage PA, Muñoz-Maniega S, Heye AK, Sakka E, Dennis MS. White matter hyperintensity reduction and outcomes after minor stroke. Neurology 2017; 89:1003-1010. [PMID: 28794252 PMCID: PMC5589793 DOI: 10.1212/wnl.0000000000004328] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/11/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess factors associated with white matter hyperintensity (WMH) change in a large cohort after observing obvious WMH shrinkage 1 year after minor stroke in several participants in a longitudinal study. METHODS We recruited participants with minor ischemic stroke and performed clinical assessments and brain MRI. At 1 year, we assessed recurrent cerebrovascular events and dependency and repeated the MRI. We assessed change in WMH volume from baseline to 1 year (normalized to percent intracranial volume [ICV]) and associations with baseline variables, clinical outcomes, and imaging parameters using multivariable analysis of covariance, model of changes, and multinomial logistic regression. RESULTS Among 190 participants (mean age 65.3 years, range 34.3-96.9 years, 112 [59%] male), WMH decreased in 71 participants by 1 year. At baseline, participants whose WMH decreased had similar WMH volumes but higher blood pressure (p = 0.0064) compared with participants whose WMH increased. At 1 year, participants with WMH decrease (expressed as percent ICV) had larger reductions in blood pressure (β = 0.0053, 95% confidence interval [CI] 0.00099-0.0097 fewer WMH per 1-mm Hg decrease, p = 0.017) and in mean diffusivity in normal-appearing white matter (β = 0.075, 95% CI 0.0025-0.15 fewer WMH per 1-unit mean diffusivity decrease, p = 0.043) than participants with WMH increase; those with WMH increase experienced more recurrent cerebrovascular events (32%, vs 16% with WMH decrease, β = 0.27, 95% CI 0.047-0.50 more WMH per event, p = 0.018). CONCLUSIONS Some WMH may regress after minor stroke, with potentially better clinical and brain tissue outcomes. The role of risk factor control requires verification. Interstitial fluid alterations may account for some WMH reversibility, offering potential intervention targets.
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Affiliation(s)
- Joanna M Wardlaw
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK.
| | - Francesca M Chappell
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Maria Del Carmen Valdés Hernández
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Stephen D J Makin
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Julie Staals
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Kirsten Shuler
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Michael J Thrippleton
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Paul A Armitage
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Susana Muñoz-Maniega
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Anna K Heye
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Eleni Sakka
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
| | - Martin S Dennis
- From the Centre for Clinical Brain Sciences (J.M.W., F.M.C., M.d.C.V.H., K.S., M.J.T., S.M.-M., A.K.H., E.S., M.S.D.), UK Dementia Research Institute at the University of Edinburgh (J.M.W.), Centre for Cognitive Aging and Cognitive Epidemiology (J.M.W., M.d.C.V.H., S.M.-M.), University of Edinburgh; Institute of Cardiovascular and Medical Sciences (S.D.J.M.), University of Glasgow, UK; Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands; and Academic Unit of Radiology (P.A.A.), Department of Cardiovascular Science, University of Sheffield, UK
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Di Donato I, Bianchi S, De Stefano N, Dichgans M, Dotti MT, Duering M, Jouvent E, Korczyn AD, Lesnik-Oberstein SAJ, Malandrini A, Markus HS, Pantoni L, Penco S, Rufa A, Sinanović O, Stojanov D, Federico A. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) as a model of small vessel disease: update on clinical, diagnostic, and management aspects. BMC Med 2017; 15:41. [PMID: 28231783 PMCID: PMC5324276 DOI: 10.1186/s12916-017-0778-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/03/2017] [Indexed: 12/11/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common and best known monogenic small vessel disease. Here, we review the clinical, neuroimaging, neuropathological, genetic, and therapeutic aspects based on the most relevant articles published between 1994 and 2016 and on the personal experience of the authors, all directly involved in CADASIL research and care. We conclude with some suggestions that may help in the clinical practice and management of these patients.
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Affiliation(s)
- Ilaria Di Donato
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Silvia Bianchi
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Marco Duering
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Eric Jouvent
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205, Paris, France.,Department of Neurology, AP-HP, Lariboisière Hospital, F-75475, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité, Paris, France
| | - Amos D Korczyn
- Department of Neurology, Tel Aviv University, Ramat Aviv, 69978, Israel
| | - Saskia A J Lesnik-Oberstein
- Department of Clinical Genetics, K5-R Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Alessandro Malandrini
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Leonardo Pantoni
- NEUROFARBA Department, Neuroscience section, Largo Brambilla 3, 50134, Florence, Italy
| | - Silvana Penco
- Medical Genetic Unit, Department of Laboratory Medicine, Niguarda Hospital, Milan, Italy
| | - Alessandra Rufa
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Osman Sinanović
- Department of Neurology, University Clinical Center Tuzla, School of Medicine University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina
| | - Dragan Stojanov
- Faculty of Medicine, University of Nis, Bul. Dr. Zorana Djindjica 81, Nis, 18000, Serbia
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy.
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Watson C, Busovaca E, Foley JM, Allen IE, Schwarz CG, Jahanshad N, Nir TM, Esmaeili-Firidouni P, Milanini B, Rosen H, Carmichael OT, Thompson PM, Valcour VG. White matter hyperintensities correlate to cognition and fiber tract integrity in older adults with HIV. J Neurovirol 2017; 23:422-429. [PMID: 28101804 DOI: 10.1007/s13365-016-0509-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/20/2016] [Accepted: 12/26/2016] [Indexed: 12/24/2022]
Abstract
Our aim was to examine the clinical relevance of white matter hyperintensities (WMH) in HIV. We used an automated approach to quantify WMH volume in HIV seropositive (HIV+; n = 65) and HIV seronegative (HIV-; n = 29) adults over age 60. We compared WMH volumes between HIV+ and HIV- groups in cross-sectional and multiple time-point analyses. We also assessed correlations between WMH volumes and cardiovascular, HIV severity, cognitive scores, and diffusion tensor imaging variables. Serostatus groups did not differ in WMH volume, but HIV+ participants had less cerebral white matter (mean: 470.95 [43.24] vs. 497.63 [49.42] mL, p = 0.010). The distribution of WMH volume was skewed in HIV+ with a high proportion (23%) falling above the 95th percentile of WMH volume defined by the HIV- group. Serostatus groups had similar amount of WMH volume growth over time. Total WMH volume directly correlated with measures of hypertension and inversely correlated with measures of global cognition, particularly in executive functioning, and psychomotor speed. Greater WMH volume was associated with poorer brain integrity measured from diffusion tensor imaging (DTI) in the corpus callosum and sagittal stratum. In this group of HIV+ individuals over 60, WMH burden was associated with cardiovascular risk and both worse diffusion MRI and cognition. The median total burden did not differ by serostatus; however, a subset of HIV+ individuals had high WMH burden.
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Affiliation(s)
- Christa Watson
- Memory and Aging Center, Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, MC: 1207, San Francisco, CA, 94158, USA.
| | - Edgar Busovaca
- Memory and Aging Center, Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, MC: 1207, San Francisco, CA, 94158, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica M Foley
- Memory and Aging Center, Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, MC: 1207, San Francisco, CA, 94158, USA
| | - I Elaine Allen
- Department of Biostatistics and Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher G Schwarz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Center for Neuroscience, Department of Neurology, University of California, Davis, Davis, CA, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, Los Angeles, CA, USA
| | - Talia M Nir
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, Los Angeles, CA, USA
| | - Pardis Esmaeili-Firidouni
- Memory and Aging Center, Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, MC: 1207, San Francisco, CA, 94158, USA
| | - Benedetta Milanini
- Memory and Aging Center, Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, MC: 1207, San Francisco, CA, 94158, USA
| | - Howard Rosen
- Memory and Aging Center, Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, MC: 1207, San Francisco, CA, 94158, USA
| | - Owen T Carmichael
- Biomedical Imaging Center, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, Los Angeles, CA, USA
| | - Victor G Valcour
- Memory and Aging Center, Department of Neurology, University of California, 675 Nelson Rising Lane, Suite 190, MC: 1207, San Francisco, CA, 94158, USA
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21
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Jouvent E, Sun ZY, De Guio F, Duchesnay E, Duering M, Ropele S, Dichgans M, Mangin JF, Chabriat H. Shape of the Central Sulcus and Disability After Subcortical Stroke. Stroke 2016; 47:1023-9. [DOI: 10.1161/strokeaha.115.012562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/10/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Eric Jouvent
- From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig
| | - Zhong Yi Sun
- From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig
| | - François De Guio
- From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig
| | - Edouard Duchesnay
- From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig
| | - Marco Duering
- From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig
| | - Stefan Ropele
- From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig
| | - Martin Dichgans
- From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig
| | - Jean-François Mangin
- From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig
| | - Hugues Chabriat
- From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig
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Stojanov D, Vojinovic S, Aracki-Trenkic A, Tasic A, Benedeto-Stojanov D, Ljubisavljevic S, Vujnovic S. Imaging characteristics of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). Bosn J Basic Med Sci 2015; 15:1-8. [PMID: 25725137 DOI: 10.17305/bjbms.2015.247] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/16/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is an autosomal dominant vascular disorder. Diagnosis and follow-up in patients with CADASIL are based mainly on magnetic resonance imaging (MRI). MRI shows white matter hyperintensities (WMHs), lacunar infarcts and cerebral microbleeds (CMBs). WMHs lesions tend to be symmetrical and bilateral, distributed in the periventricular and deep white matter. The anterior temporal lobe and external capsules are predilection sites for WMHs, with higher specificity and sensitivity of anterior temporal lobe involvement compared to an external capsule involvement. Lacunar infarcts are presented by an imaging signal that has intensity of cerebrospinal fluid in all MRI sequences. They are localized within the semioval center, thalamus, basal ganglia and pons. CMBs are depicted as focal areas of signal loss on T2 images which increases in size on the T2*-weighted gradient echo planar images ("blooming effect").
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Affiliation(s)
- Dragan Stojanov
- Faculty of Medicine University of Niš, Serbia Center of Radiology, Clinical Center Niš, Serbia.
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