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Huang WQ, Lin Q, Tzeng CM. Leukoaraiosis: Epidemiology, Imaging, Risk Factors, and Management of Age-Related Cerebral White Matter Hyperintensities. J Stroke 2024; 26:131-163. [PMID: 38836265 PMCID: PMC11164597 DOI: 10.5853/jos.2023.02719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
Leukoaraiosis (LA) manifests as cerebral white matter hyperintensities on T2-weighted magnetic resonance imaging scans and corresponds to white matter lesions or abnormalities in brain tissue. Clinically, it is generally detected in the early 40s and is highly prevalent globally in individuals aged >60 years. From the imaging perspective, LA can present as several heterogeneous forms, including punctate and patchy lesions in deep or subcortical white matter; lesions with periventricular caps, a pencil-thin lining, and smooth halo; as well as irregular lesions, which are not always benign. Given its potential of having deleterious effects on normal brain function and the resulting increase in public health burden, considerable effort has been focused on investigating the associations between various risk factors and LA risk, and developing its associated clinical interventions. However, study results have been inconsistent, most likely due to potential differences in study designs, neuroimaging methods, and sample sizes as well as the inherent neuroimaging heterogeneity and multi-factorial nature of LA. In this article, we provided an overview of LA and summarized the current knowledge regarding its epidemiology, neuroimaging classification, pathological characteristics, risk factors, and potential intervention strategies.
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Affiliation(s)
- Wen-Qing Huang
- Department of Central Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Lin
- Department of Neurology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Clinical Research Center for Brain Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- The Third Clinical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Chi-Meng Tzeng
- Translational Medicine Research Center, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian, China
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Phyo AZZ, Fransquet PD, Wrigglesworth J, Woods RL, Espinoza SE, Ryan J. Sex differences in biological aging and the association with clinical measures in older adults. GeroScience 2024; 46:1775-1788. [PMID: 37747619 PMCID: PMC10828143 DOI: 10.1007/s11357-023-00941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
Females live longer than males, and there are sex disparities in physical health and disease incidence. However, sex differences in biological aging have not been consistently reported and may differ depending on the measure used. This study aimed to determine the correlations between epigenetic age acceleration (AA), and other markers of biological aging, separately in males and females. We additionally explored the extent to which these AA measures differed according to socioeconomic characteristics, clinical markers, and diseases. Epigenetic clocks (HorvathAge, HannumAge, PhenoAge, GrimAge, GrimAge2, and DunedinPACE) were estimated in blood from 560 relatively healthy Australians aged ≥ 70 years (females, 50.7%) enrolled in the ASPREE study. A system-wide deficit accumulation frailty index (FI) composed of 67 health-related measures was generated. Brain age and subsequently brain-predicted age difference (brain-PAD) were estimated from neuroimaging. Females had significantly reduced AA than males, but higher FI, and there was no difference in brain-PAD. FI had the strongest correlation with DunedinPACE (range r: 0.21 to 0.24 in both sexes). Brain-PAD was not correlated with any biological aging measures. Significant correlations between AA and sociodemographic characteristics and health markers were more commonly found in females (e.g., for DunedinPACE and systolic blood pressure r = 0.2, p < 0.001) than in males. GrimAA and Grim2AA were significantly associated with obesity and depression in females, while in males, hypertension, diabetes, and chronic kidney disease were associated with these clocks, as well as DunedinPACE. Our findings highlight the importance of considering sex differences when investigating the link between biological age and clinical measures.
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Affiliation(s)
- Aung Zaw Zaw Phyo
- Biological Neuropsychiatry & Dementia Unit, School of Public Health and Preventive Medicine, Monash University, 553, St. Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Peter D Fransquet
- Biological Neuropsychiatry & Dementia Unit, School of Public Health and Preventive Medicine, Monash University, 553, St. Kilda Road, Melbourne, VIC, 3004, Australia
- School of Psychology, Deakin University, Burwood, Melbourne, VIC, 3125, Australia
| | - Jo Wrigglesworth
- Biological Neuropsychiatry & Dementia Unit, School of Public Health and Preventive Medicine, Monash University, 553, St. Kilda Road, Melbourne, VIC, 3004, Australia
| | - Robyn L Woods
- ASPREE Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Sara E Espinoza
- Center for Translational Geroscience, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joanne Ryan
- Biological Neuropsychiatry & Dementia Unit, School of Public Health and Preventive Medicine, Monash University, 553, St. Kilda Road, Melbourne, VIC, 3004, Australia
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Parker EJ, Orchard SG, Gilbert TJ, Phung JJ, Owen AJ, Lockett T, Nelson MR, Reid CM, Tonkin AM, Abhayaratna WP, Gibbs P, McNeil JJ, Woods RL. The ASPREE Healthy Ageing Biobank: Methodology and participant characteristics. PLoS One 2024; 19:e0294743. [PMID: 38421995 PMCID: PMC10903821 DOI: 10.1371/journal.pone.0294743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/07/2023] [Indexed: 03/02/2024] Open
Abstract
ASPirin in Reducing Events in the Elderly (ASPREE), a placebo-controlled prevention trial of low dose aspirin, provided the opportunity to establish a biospecimen biobank from initially healthy persons aged 70+ years for future research. The ASPREE Healthy Ageing Biobank (ASPREE Biobank) collected, processed and stored blood and urine samples at -80degC or under nitrogen vapour at two timepoints, three years apart, from a willing subset of Australian ASPREE participants. Written informed consent included separate opt-in questions for biomarker and genetic testing. Fractionated blood and urine were aliquoted into multiple low-volume, barcoded cryotubes for frozen storage within 4 hours of collection. Specially designed and outfitted mobile laboratories provided opportunities for participation by people in regional and rural areas. Detailed, high quality demographic, physiological and clinical data were collected annually through the ASPREE trial. 12,219 participants contributed blood/urine at the first timepoint, 10,617 of these older adults provided 3-year follow-up samples, and an additional 1,712 provided saliva for DNA. The mean participant age was 74 years, 54% were female and 46% lived outside major cities. Despite geographical and logistical challenges, nearly 100% of blood/urine specimens were processed and frozen within 4 hours of collection into >1.4 million aliquots. After a median of 4.7 years, major clinical events among ASPREE Biobank participants included 332 with dementia, 613 with cardiovascular disease events, 1259 with cancer, 357 with major bleeds and 615 had died. The ASPREE Biobank houses and curates a large number of biospecimens collected prior to the clinical manifestations of major disease, and 3-year follow-up samples, all linked to high quality, extensive phenotypic information. This provides the opportunity to identify or validate diagnostic, prognostic and predictive biomarkers, and potentially study biological effectors, of ageing-related diseases or maintenance of older-age good health.
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Affiliation(s)
- Emily J Parker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tom J Gilbert
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - James J Phung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Trevor Lockett
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, North Ryde, New South Wales, Australia
- Technical Director, Rhythm Biosciences Ltd, Parkville, Victoria, Australia
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Walter P Abhayaratna
- ANU Medical School, Australian National University, Garran, Australian Capital Territory, Australia
| | - Peter Gibbs
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ernst ME, Broder JC, Wolfe R, Woods RL, Nelson MR, Ryan J, Shah RC, Orchard SG, Chan AT, Espinoza SE, Wilson M, Kirpach B, Reid CM, McNeil JJ, Williamson JD, Murray AM. Health Characteristics and Aspirin Use in Participants at the Baseline of the ASPirin in Reducing Events in the Elderly - eXTension (ASPREE-XT) Observational Study. Contemp Clin Trials 2023; 130:107231. [PMID: 37196887 PMCID: PMC10330669 DOI: 10.1016/j.cct.2023.107231] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Aspirin as a primary preventative in healthy older adults did not prolong disability-free survival in the ASPREE randomized trial. Observational studies following randomized trials allow assessment of benefits and harms which may not appear during the trial. We describe health characteristics, physical function, and aspirin use in the ASPREE-eXTension (ASPREE-XT) observational study cohort. METHODS Descriptive statistics compared health characteristics of those consented to ASPREE-XT at their first post-trial baseline (XT01) to corresponding ASPREE baseline values, and to those not consented. Likelihood of an indication for aspirin was assessed in participants reporting aspirin use at XT01. RESULTS 16,317 (93%) of the remaining and eligible 17,546 ASPREE participants were consented into ASPREE-XT; 14,894 completed XT01. Mean participant age had increased from 74.9 to 80.6 years. Overall health and physical function declined from the original ASPREE baseline; more participants were living alone, there was higher prevalence of chronic kidney disease, diabetes, and frailty, grip strength was lower and gait speed slower. Those not consented into ASPREE-XT were slightly older, and had lower cognitive scores and higher prevalence of age-related conditions than those who continued. 1015/11,717 (8.7%) participants without an apparent indication for aspirin reported using aspirin at XT01. CONCLUSIONS The ASPREE-XT cohort was slightly less healthy at the XT01 visit than at ASPREE trial initiation, and rates of aspirin use without indication were similar to ASPREE baseline. Participants will be followed long-term to investigate aspirin's potential legacy towards dementia and cancer prevention and explore determinants of healthy aging.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, United States of America; Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States of America.
| | - Jonathan C Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Raj C Shah
- Department of Family and Preventive Medicine and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States of America
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Sara E Espinoza
- Division of Geriatrics, Gerontology & Palliative Medicine, and Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States of America; Geriatric Research Education & Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, United States of America
| | - Michelle Wilson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Brenda Kirpach
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Population Health, Curtin University; Perth, WA, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jeff D Williamson
- Sticht Centre on Health Aging and Alzheimer's Prevention, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America; Division of Geriatrics, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States of America
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Gutteridge DS, Segal A, McNeil JJ, Beilin L, Brodtmann A, Chowdhury EK, Egan GF, Ernst ME, Hussain SM, Reid CM, Robb CE, Ryan J, Woods RL, Keage HA, Jamadar S. The relationship between long-term blood pressure variability and cortical thickness in older adults. Neurobiol Aging 2023; 129:157-167. [PMID: 37331246 DOI: 10.1016/j.neurobiolaging.2023.05.011] [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: 01/17/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023]
Abstract
High blood pressure variability (BPV) is a risk factor for cognitive decline and dementia, but its association with cortical thickness is not well understood. Here we use a topographical approach, to assess links between long-term BPV and cortical thickness in 478 (54% men at baseline) community dwelling older adults (70-88 years) from the ASPirin in Reducing Events in the Elderly NEURO sub-study. BPV was measured as average real variability, based on annual visits across three years. Higher diastolic BPV was significantly associated with reduced cortical thickness in multiple areas, including temporal (banks of the superior temporal sulcus), parietal (supramarginal gyrus, post-central gyrus), and posterior frontal areas (pre-central gyrus, caudal middle frontal gyrus), while controlling for mean BP. Higher diastolic BPV was associated with faster progression of cortical thinning across the three years. Diastolic BPV is an important predictor of cortical thickness, and trajectory of cortical thickness, independent of mean blood pressure. This finding suggests an important biological link in the relationship between BPV and cognitive decline in older age.
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Affiliation(s)
- D S Gutteridge
- Cognitive Ageing and Impairment Neuroscience Laboratory (CAIN), University of South Australia, Adelaide, South Australia, Australia.
| | - A Segal
- Turner Institute for Brain & Mental Health, Monash University, Melbourne, Victoria, Australia
| | - J J McNeil
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - L Beilin
- School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - A Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - E K Chowdhury
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - G F Egan
- Turner Institute for Brain & Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - M E Ernst
- Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, IA, USA; Department of Pharmacy Practice and Science, College of Pharmacy, Carver College of Medicine. The University of Iowa, Iowa City, IA, USA
| | - S M Hussain
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - C M Reid
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - C E Robb
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Ryan
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - R L Woods
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - H A Keage
- Cognitive Ageing and Impairment Neuroscience Laboratory (CAIN), University of South Australia, Adelaide, South Australia, Australia
| | - S Jamadar
- Turner Institute for Brain & Mental Health, Monash University, Melbourne, Victoria, Australia; Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
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Wrigglesworth J, Harding IH, Islam RM, Ward PGD, Woods RL, Bell RJ, McNeil JJ, Storey E, Egan G, Murray AM, Trevaks RE, Ward SA, Davis SR, Ryan J. The association between sex hormones and the change in brain-predicted age difference in older women. Clin Endocrinol (Oxf) 2023; 98:692-699. [PMID: 36807922 PMCID: PMC10073334 DOI: 10.1111/cen.14898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/17/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE The role of circulating sex hormones on structural brain ageing is yet to be established. This study explored whether concentrations of circulating sex hormones in older women are associated with the baseline and longitudinal changes in structural brain ageing, defined by the brain-predicted age difference (brain-PAD). DESIGN Prospective cohort study using data from NEURO and Sex Hormones in Older Women; substudies of the ASPirin in Reducing Events in the Elderly clinical trial. PATIENTS Community-dwelling older women (aged 70+ years). MEASUREMENTS Oestrone, testosterone, dehydroepiandrosterone (DHEA), and sex-hormone binding globulin (SHBG) were quantified from plasma samples collected at baseline. T1-weighted magnetic resonance imaging was performed at baseline, 1 and 3 years. Brain age was derived from whole brain volume using a validated algorithm. RESULTS The sample comprised of 207 women not taking medications known to influence sex hormone concentrations. A statistically higher baseline brain-PAD (older brain age relative to chronological age) was seen for women in the highest DHEA tertile compared with the lowest in the unadjusted analysis (p = .04). This was not significant when adjusted for chronological age, and potential confounding health and behavioural factors. Oestrone, testosterone and SHBG were not associated with brain-PAD cross-sectionally, nor were any of the examined sex hormones or SHBG associated with brain-PAD longitudinally. CONCLUSION No strong evidence of an association between circulating sex hormones and brain-PAD. Given there is prior evidence to suggests sex hormones may be important for brain ageing, further studies of circulating sex hormones and brain health in postmenopausal women are warranted.
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Affiliation(s)
- Jo Wrigglesworth
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Ian H. Harding
- Monash Biomedical Imaging, Monash University, Melbourne, 3800, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne Victoria, Australia
| | - Rakibul M. Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Phillip G. D. Ward
- Monash Biomedical Imaging, Monash University, Melbourne, 3800, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, 3800, Victoria Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Robin J. Bell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Gary Egan
- Monash Biomedical Imaging, Monash University, Melbourne, 3800, Victoria, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Australia
| | - Anne M. Murray
- Berman Centre for Outcomes & Clinical Research, Hennepin Healthcare Research Institute, Hennepin, Minneapolis, MN, 55404, USA
- Department of Medicine, Division of Geriatrics, Hennepin Healthcare, University of Minnesota, Minneapolis, MN, 55404, USA
| | - Ruth E. Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Stephanie A. Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, 2031, New South Wales, Australia
| | - Susan R. Davis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, 3004, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
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Wrigglesworth J, Ryan J, Ward PGD, Woods RL, Storey E, Egan GF, Murray A, Espinoza SE, Shah RC, Trevaks RE, Ward SA, Harding IH. Health-related heterogeneity in brain aging and associations with longitudinal change in cognitive function. Front Aging Neurosci 2023; 14:1063721. [PMID: 36688169 PMCID: PMC9846261 DOI: 10.3389/fnagi.2022.1063721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Neuroimaging-based 'brain age' can identify individuals with 'advanced' or 'resilient' brain aging. Brain-predicted age difference (brain-PAD) is predictive of cognitive and physical health outcomes. However, it is unknown how individual health and lifestyle factors may modify the relationship between brain-PAD and future cognitive or functional performance. We aimed to identify health-related subgroups of older individuals with resilient or advanced brain-PAD, and determine if membership in these subgroups is differentially associated with changes in cognition and frailty over three to five years. Methods Brain-PAD was predicted from T1-weighted images acquired from 326 community-dwelling older adults (73.8 ± 3.6 years, 42.3% female), recruited from the larger ASPREE (ASPirin in Reducing Events in the Elderly) trial. Participants were grouped as having resilient (n=159) or advanced (n=167) brain-PAD, and latent class analysis (LCA) was performed using a set of cognitive, lifestyle, and health measures. We examined associations of class membership with longitudinal change in cognitive function and frailty deficit accumulation index (FI) using linear mixed models adjusted for age, sex and education. Results Subgroups of resilient and advanced brain aging were comparable in all characteristics before LCA. Two typically similar latent classes were identified for both subgroups of brain agers: class 1 were characterized by low prevalence of obesity and better physical health and class 2 by poor cardiometabolic, physical and cognitive health. Among resilient brain agers, class 1 was associated with a decrease in cognition, and class 2 with an increase over 5 years, though was a small effect that was equivalent to a 0.04 standard deviation difference per year. No significant class distinctions were evident with FI. For advanced brain agers, there was no evidence of an association between class membership and changes in cognition or FI. Conclusion These results demonstrate that the relationship between brain age and cognitive trajectories may be influenced by other health-related factors. In particular, people with age-resilient brains had different trajectories of cognitive change depending on their cognitive and physical health status at baseline. Future predictive models of aging outcomes will likely be aided by considering the mediating or synergistic influence of multiple lifestyle and health indices alongside brain age.
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Affiliation(s)
- Jo Wrigglesworth
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Phillip G. D. Ward
- Monash Biomedical Imaging, Monash University, Clayton, Vic, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Clayton, Vic, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Gary F. Egan
- Monash Biomedical Imaging, Monash University, Clayton, Vic, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Clayton, Vic, Australia
| | - Anne Murray
- Hennepin Healthcare and Berman Center for Outcomes & Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Division of Geriatrics, Hennepin Healthcare, University of Minnesota, Minneapolis, MN, United States
| | - Sara E. Espinoza
- Division of Geriatrics, Gerontology & Palliative Medicine, Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, Houston, TX, United States
- Geriatric Research, Education & Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Raj C. Shah
- Department of Family & Preventive Medicine and the Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - Ruth E. Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Stephanie A. Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Ian H. Harding
- Monash Biomedical Imaging, Monash University, Clayton, Vic, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Silent brain infarcts, peripheral vascular disease and the risk of cardiovascular events in patients with hypertension. J Hypertens 2022; 40:1469-1477. [PMID: 35881448 DOI: 10.1097/hjh.0000000000003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS We aimed to study the relationship between cerebral small vessel disease (cSVD) lesions, as markers of subclinical target organ damage (TOD) in the brain, and incident cardiovascular events (CVE). METHODS Data from the ISSYS (Investigating Silent Strokes in hYpertensives Study), which is a longitudinal and observational study conducted in patients with hypertension aged 50-70 years, and stroke-free at the inclusion. At the baseline visit, participants underwent a clinical interview, a brain MRI, urine and blood sampling collection and vascular testing studies. Therefore, we obtained markers of TOD from the brain [white matter hyperintensities, silent brain infarcts (SBI), cerebral microbleeds and enlarged perivascular spaces (EPVS)], from kidney (microalbuminuria, glomerular filtration) and regarding large vessels [ankle-to-brachial index (ABI), carotid-femoral pulse wave velocity]. Survival analyses were used to assess the relationship between these predictors and the incidence of cardiovascular events (CVE). RESULTS We followed-up 964 individuals within a median time of 5 years (4.7-5), representing 4377.1 persons-year. We found 73 patients presenting incident CVE, which corresponds to a rate of 8.2%. We found ABI less than 0.9 [hazard ratio, 2.2; 95% confidence interval (CI) 1.17-4.13, P value = 0.014] and SBI (hazard ratio, 2.9; 95% CI 1.47-5.58, P value = 0.002) independently associated with higher risk of incident CVE. The inclusion of both variables in a clinical model resulted in an increased discrimination of individuals with new CVE of 4.72%, according to the integrated discrimination index. CONCLUSION Assessment of SBI and ABI less than 0.9 may refine the cardiovascular risk stratification in patients with hypertension.
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Kwan J, Hafdi M, Chiang LLW, Myint PK, Wong LS, Quinn TJ. Antithrombotic therapy to prevent cognitive decline in people with small vessel disease on neuroimaging but without dementia. Cochrane Database Syst Rev 2022; 7:CD012269. [PMID: 35833913 PMCID: PMC9281623 DOI: 10.1002/14651858.cd012269.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cerebral small vessel disease is a progressive disease of the brain's deep perforating blood vessels. It is usually diagnosed based on lesions seen on brain imaging. Cerebral small vessel disease is a common cause of stroke but can also cause a progressive cognitive decline. As antithrombotic therapy is an established treatment for stroke prevention, we sought to determine whether antithrombotic therapy might also be effective in preventing cognitive decline in people with small vessel disease. OBJECTIVES To assess the effects of antithrombotic therapy for prevention of cognitive decline in people with small vessel disease on neuroimaging but without dementia. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Review Group's Specialised Register, and the Cochrane Stroke Group's Specialised Register; the most recent search was on 21 July 2021. We also searched MEDLINE, Embase, four other databases and two trials registries. We searched the reference lists of the articles retrieved from these searches. As trials with a stroke focus may include relevant subgroup data, we complemented these searches with a focussed search of all antithrombotic titles in the Cochrane Stroke Group database. SELECTION CRITERIA: We included randomised controlled trials (RCT) of people with neuroimaging evidence of at least mild cerebral small vessel disease (defined here as white matter hyperintensities, lacunes of presumed vascular origin and subcortical infarcts) but with no evidence of dementia. The trials had to compare antithrombotic therapy of minimum 24 weeks' duration to no antithrombotic therapy (either placebo or treatment as usual), or compare different antithrombotic treatment regimens. Antithrombotic therapy could include antiplatelet agents (as monotherapy or combination therapy), anticoagulants or a combination. DATA COLLECTION AND ANALYSIS Two review authors independently screened all the titles identified by the searches. We assessed full texts for eligibility for inclusion according to our prespecified selection criteria, extracted data to a proforma and assessed risk of bias using the Cochrane tool for RCTs. We evaluated the certainty of evidence using GRADE. Due to heterogeneity across included participants, interventions and outcomes of eligible trials, it was not possible to perform meta-analyses. MAIN RESULTS We included three RCTs (3384 participants). One study investigated the effect of antithrombotic therapy in participants not yet on antithrombotic therapy; two studies investigated the effect of additional antithrombotic therapy, one in a population already taking a single antithrombotic agent and one in a mixed population (participants on an antithrombotic drug and antithrombotic-naive participants). Intervention and follow-up durations varied from 24 weeks to four years. Jia 2016 was a placebo-controlled trial assessing 24 weeks of treatment with DL-3-n-butylphthalide (a compound with multimodal actions, including a putative antiplatelet effect) in 280 Chinese participants with vascular cognitive impairment caused by subcortical ischaemic small vessel disease, but without dementia. There was very low-certainty evidence for a small difference in cognitive test scores favouring treatment with DL-3-n-butylphthalide, as measured by the 12-item Alzheimer's Disease Assessment Scale-Cognitive subscale (adjusted mean difference -1.07, 95% confidence interval (CI) -2.02 to -0.12), but this difference may not be clinically relevant. There was also very low-certainty evidence for greater proportional improvement measured with the Clinician Interview-Based Impression of Change-Plus Caregiver Input (57% with DL-3-n-butylphthalide versus 42% with placebo; P = 0.01), but there was no difference in other measures of cognition (Mini-Mental State Examination and Clinical Dementia Rating) or function. There was no evidence of a difference in adverse events between treatment groups. The SILENCE RCT compared antithrombotic therapy (aspirin) and placebo during four years of treatment in 83 participants with 'silent brain infarcts' who were on no prior antithrombotic therapy. There was very low-certainty evidence for no difference between groups across various measures of cognition and function, rates of stroke or adverse events. The Secondary Prevention of Subcortical Stroke Study (SPS3) compared dual antiplatelet therapy (clopidogrel plus aspirin) to aspirin alone in 3020 participants with recent lacunar stroke. There was low-certainty evidence of no effect on cognitive outcomes as measured by the Cognitive Abilities Screening Instruments (CASI) assessed annually over five years. There was also low-certainty evidence of no difference in the annual incidence of mild cognitive decline between the two treatment groups (9.7% with dual antiplatelet therapy versus 9.9% with aspirin), or the annual stroke recurrence rate (2.5% with dual antiplatelet therapy versus 2.7% with aspirin). Bleeding risk may be higher with dual antiplatelet therapy (hazard ratio (HR) 2.15, 95% CI 1.49 to 3.11; low certainty evidence), but there may be no significant increase in intracerebral bleeding risk (HR 1.52, 95% CI 0.79 to 2.93; low-certainty evidence). None of the included trials assessed the incidence of new dementia. AUTHORS' CONCLUSIONS We found no convincing evidence to suggest any clinically relevant cognitive benefit of using antithrombotic therapy in addition to standard treatment in people with cerebral small vessel disease but without dementia, but there may be an increased bleeding risk with this approach. There was marked heterogeneity across the trials and the certainty of the evidence was generally poor.
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Affiliation(s)
- Joseph Kwan
- Department of Brain Sciences, Imperial College London, London, UK
| | - Melanie Hafdi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lorraine L W Chiang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Phyo K Myint
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Li Siang Wong
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Wrigglesworth J, Harding IH, Ward P, Woods RL, Storey E, Fitzgibbon B, Egan G, Murray A, Shah RC, Trevaks RE, Ward S, McNeil JJ, Ryan J. Factors Influencing Change in Brain-Predicted Age Difference in a Cohort of Healthy Older Individuals. J Alzheimers Dis Rep 2022; 6:163-176. [PMID: 35591948 PMCID: PMC9108625 DOI: 10.3233/adr-220011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/09/2022] [Indexed: 12/11/2022] Open
Abstract
Background: There is considerable variability in the rate at which we age biologically, and the brain is particularly susceptible to the effects of aging. Objective: We examined the test-retest reliability of brain age at one- and three-year intervals and identified characteristics that predict the longitudinal change in brain-predicted age difference (brain-PAD, defined by deviations of brain age from chronological age). Methods: T1-weighted magnetic resonance images were acquired at three timepoints from 497 community-dwelling adults (73.8±3.5 years at baseline, 48% were female). Brain age was estimated from whole brain volume, using a publicly available algorithm trained on an independent dataset. Linear mixed models were used, adjusting for sex, age, and age2. Results: Excellent retest reliability of brain age was observed over one and three years. We identified a significant sex difference in brain-PAD, where a faster rate of brain aging (worsening in brain age relative to chronological age) was observed in men, and this finding replicated in secondary analyses. The effect size, however, was relatively weak, equivalent to 0.16 years difference per year. A higher score in physical health related quality of life and verbal fluency were associated with a faster rate of brain aging, while depression was linked to a slower rate of brain aging, but these findings were not robust. Conclusion: Our study provides consistent evidence that older men have slightly faster brain atrophy than women. Given the sparsity of longitudinal research on brain age in older populations, future prospective studies are needed to confirm our findings.
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Affiliation(s)
- Jo Wrigglesworth
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ian H. Harding
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Phillip Ward
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Clayton, VIC, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bernadette Fitzgibbon
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Gary Egan
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Clayton, VIC, Australia
| | - Anne Murray
- Berman Center for Outcomes & Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- Department of Medicine, Division of Geriatrics, Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Raj C. Shah
- Department of Family Medicine and the Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Ruth E. Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stephanie Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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11
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Jourdi G, Godier A, Lordkipanidzé M, Marquis-Gravel G, Gaussem P. Antiplatelet Therapy for Atherothrombotic Disease in 2022—From Population to Patient-Centered Approaches. Front Cardiovasc Med 2022; 9:805525. [PMID: 35155631 PMCID: PMC8832164 DOI: 10.3389/fcvm.2022.805525] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022] Open
Abstract
Antiplatelet agents, with aspirin and P2Y12 receptor antagonists as major key molecules, are currently the cornerstone of pharmacological treatment of atherothrombotic events including a variety of cardio- and cerebro-vascular as well as peripheral artery diseases. Over the last decades, significant changes have been made to antiplatelet therapeutic and prophylactic strategies. The shift from a population-based approach to patient-centered precision medicine requires greater awareness of individual risks and benefits associated with the different antiplatelet strategies, so that the right patient gets the right therapy at the right time. In this review, we present the currently available antiplatelet agents, outline different management strategies, particularly in case of bleeding or in perioperative setting, and develop the concept of high on-treatment platelet reactivity and the steps toward person-centered precision medicine aiming to optimize patient care.
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Affiliation(s)
- Georges Jourdi
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- *Correspondence: Georges Jourdi
| | - Anne Godier
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- Department of Anesthesiology and Critical Care, AP-HP, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie Lordkipanidzé
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Guillaume Marquis-Gravel
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Pascale Gaussem
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- Service d'Hématologie Biologique, AP-HP, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
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12
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Brain-predicted age difference is associated with cognitive processing in later-life. Neurobiol Aging 2021; 109:195-203. [PMID: 34775210 DOI: 10.1016/j.neurobiolaging.2021.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023]
Abstract
Brain age is a neuroimaging-based biomarker of aging. This study examined whether the difference between brain age and chronological age (brain-PAD) is associated with cognitive function at baseline and longitudinally. Participants were relatively healthy, predominantly white community-dwelling older adults (n = 531, aged ≥70 years), with high educational attainment (61% ≥12 years) and socioeconomic status (59% ≥75th percentile). Brain age was estimated from T1-weighted magnetic resonance images using an algorithm by Cole et al., 2018. After controlling for age, gender, education, depression and body mass index, brain-PAD was negatively associated with psychomotor speed (Symbol Digit Modalities Test) at baseline (Bonferroni p < 0.006), but was not associated with baseline verbal fluency (Controlled Oral Word Association Test), delayed recall (Hopkins Learning Test Revised), or general cognitive status (Mini-Mental State Examination). Baseline brain-PAD was not associated with 3-year change in cognition (Bonferroni p > 0.006). These findings indicate that even in relatively healthy older people, accelerated brain aging is associated with worse psychomotor speed, but future longitudinal research into changes in brain-PAD is needed.
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13
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Zhou T, Mei J, Hou M. Clinical study of double anti-platelet therapy combined with different doses of statin in the treatment of acute cerebral infarction complicated with microhemorrhage. Am J Transl Res 2021; 13:12043-12050. [PMID: 34786140 PMCID: PMC8581898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the clinical effect and safety of double anti-platelet therapy combined with different doses of statins for acute cerebral infarction complicated with microhemorrhage. METHODS A total of 312 patients who had acute cerebral infarction complicated with microhemorrhage in our hospital were randomly allocated into two groups: the experimental group (n=164) and group for control (n=148). Those in the group for experiment received dual antiplatelet rosuvastatin tablets (20 mg QN), while the control group received dual antiplatelet rosuvastatin tablets (10 mg QN). After 30 days of treatment, blood biochemistry and brain magnetic resonance imaging were performed to record the serum lipid levels, liver transaminase, inflammatory and oxidative stress indicators and other biochemical indicators as well as the number of cerebral microhemorrhage foci. RESULTS Serum lipids in both groups after intervention were decreased compared to those without intervention (P < 0.05). Furthermore, after receiving the intervention, the HCY and inflammatory indicators (such as hs-CRP) of the two groups were improved compared to before intervention (P < 0.05). The safety index (Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Creatine kinase (CK), creatinine (Cr)) had no statistically significant difference than those without intervention in the two groups (P > 0.05). CONCLUSION Rosuvastatin can effectively regulate blood lipids and Hcy levels in patients with acute cerebral infarction and microbleeds, and it can reduce blood lipids and inflammation; furthermore, high dose rosuvastatin has better improvement effects and higher safety in a shorter period time.
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Affiliation(s)
- Ting Zhou
- Department of Neurology, People’s Hospital of Dongxihu DistrictWuhan 430040, China
| | - Junhua Mei
- Department of Neurology, The First Hospital of Wuhan CityWuhan 430033, China
| | - Min Hou
- Department of Cardiology, People’s Hospital of Dongxihu DistrictWuhan 430040, China
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14
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Orchard ER, Ward PGD, Chopra S, Storey E, Egan GF, Jamadar SD. Neuroprotective Effects of Motherhood on Brain Function in Late Life: A Resting-State fMRI Study. Cereb Cortex 2021; 31:1270-1283. [PMID: 33067999 PMCID: PMC7906778 DOI: 10.1093/cercor/bhaa293] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022] Open
Abstract
The maternal brain undergoes structural and functional plasticity during pregnancy and the postpartum period. Little is known about functional plasticity outside caregiving-specific contexts and whether changes persist across the lifespan. Structural neuroimaging studies suggest that parenthood may confer a protective effect against the aging process; however, it is unknown whether parenthood is associated with functional brain differences in late life. We examined the relationship between resting-state functional connectivity and number of children parented in 220 healthy older females (73.82 ± 3.53 years) and 252 healthy older males (73.95 ± 3.50 years). We compared the patterns of resting-state functional connectivity with 3 different models of age-related functional change to assess whether these effects may be functionally neuroprotective for the aging human parental brain. No relationship between functional connectivity and number of children was obtained for males. For females, we found widespread decreasing functional connectivity with increasing number of children parented, with increased segregation between networks, decreased connectivity between hemispheres, and decreased connectivity between anterior and posterior regions. The patterns of functional connectivity related to the number of children an older woman has parented were in the opposite direction to those usually associated with age-related cognitive decline, suggesting that motherhood may be beneficial for brain function in late life.
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Affiliation(s)
- Edwina R Orchard
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
| | - Phillip G D Ward
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
| | - Sidhant Chopra
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC 3800, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC 3800, Australia
- Department of Neuroscience (Medicine), Monash University, The Alfred Centre, Melbourne, VIC 3800, Australia
| | - Gary F Egan
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
| | - Sharna D Jamadar
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
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15
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Magnetic resonance imaging manifestations of cerebral small vessel disease: automated quantification and clinical application. Chin Med J (Engl) 2020; 134:151-160. [PMID: 33443936 PMCID: PMC7817342 DOI: 10.1097/cm9.0000000000001299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The common cerebral small vessel disease (CSVD) neuroimaging features visible on conventional structural magnetic resonance imaging include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. The CSVD neuroimaging features have shared and distinct clinical consequences, and the automatic quantification methods for these features are increasingly used in research and clinical settings. This review article explores the recent progress in CSVD neuroimaging feature quantification and provides an overview of the clinical consequences of these CSVD features as well as the possibilities of using these features as endpoints in clinical trials. The added value of CSVD neuroimaging quantification is also discussed for researches focused on the mechanism of CSVD and the prognosis in subjects with CSVD.
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16
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Robman LD, Phuong Thao LT, Guymer RH, Wolfe R, Woods RL, Hodgson LAB, Phung J, Makeyeva GA, Le-Pham YA, Orchard SG, Suleiman J, Maguire E, Trevaks RE, Ward SA, Riaz M, Lacaze P, Storey E, Abhayaratna WP, Nelson MR, Ernst ME, Reid CM, McNeil JJ. Baseline characteristics and age-related macular degeneration in participants of the "ASPirin in Reducing Events in the Elderly" (ASPREE)-AMD trial. Contemp Clin Trials Commun 2020; 20:100667. [PMID: 33210016 PMCID: PMC7658662 DOI: 10.1016/j.conctc.2020.100667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/22/2020] [Accepted: 10/03/2020] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To describe the baseline participant characteristics in the ASPREE-AMD study, investigating the effect of aspirin on AMD incidence and progression. METHODS Australian participants from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, randomized to 100 mg aspirin daily or placebo, had non-mydriatic, digital color fundus images graded according to the Beckman AMD classification. Associations with AMD were determined for baseline characteristics and genetic risk variants. RESULTS ASPREE-AMD sub-study enrolled 4993 participants with gradable macular images. Median age was 73.4 years (IQR, 71.5, 76.6), 52% were female, 10% had diabetes mellitus, 73% had hypertension, and 44% were former/current smokers. Early, intermediate and late AMD (detected in 20.6%, 16.1%, 1.1%, respectively), significantly associated with age, were also associated with increasing HDL levels: OR = 1.52 (95%CI, 1.26, 1.84), OR = 1.43 (1.17, 1.77) and OR = 1.96 (1.02, 3.76), respectively. Female sex was associated with early [OR = 1.37 (1.16, 1.62)], and intermediate [OR = 1.35 (1.12, 1.63)] AMD, as was previous regular use of aspirin, with OR = 1.46 (1.11, 1.92) and OR = 1.37 (1.01, 1.85), respectively. Current smoking had increased odds for late AMD, OR = 4.02 (1.42, 11.36). Genetic risk variant rs3750846 (ARMS2/HTRA1) was associated with each AMD stage (p < 0.001), risk variants rs570618 and rs10922109 (CFH) with intermediate and late AMD (p < 0.001), and rare variant rs147859257 (C3) with late AMD (p < 0.001). The randomized groups were well balanced for all analyzed AMD risk factors. CONCLUSIONS Observed associations are typical of AMD. The ASPREE-AMD clinical trial provides a unique opportunity to determine the risks and benefits of low-dose aspirin for AMD incidence and progression in elderly population. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry: ACTRN 12613000755730.
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Affiliation(s)
- Liubov D. Robman
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia,Corresponding author. Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Coordinating Centre, 99 Commercial Road, Melbourne, 3004, Victoria, Australia.
| | - Le Thi Phuong Thao
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Robyn H. Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Robyn L. Woods
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Lauren AB. Hodgson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - James Phung
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Galina A. Makeyeva
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Y-Anh Le-Pham
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Suzanne G. Orchard
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jewhara Suleiman
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Emily Maguire
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Ruth E. Trevaks
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Stephanie A. Ward
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Moeen Riaz
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Walter P. Abhayaratna
- College of Health and Medicine, The Australian National University, Canberra, ACT, 0200, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, 52242, USA
| | - Christopher M. Reid
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - John J. McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
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17
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Casolla B, Cordonnier C. Intracerebral haemorrhage, microbleeds and antithrombotic drugs. Rev Neurol (Paris) 2020; 177:11-22. [PMID: 32747048 DOI: 10.1016/j.neurol.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
Antithrombotic therapy is a cornerstone for secondary prevention of ischaemic events, cerebral and extra-cerebral. A number of clinical questions remain unanswered concerning the impact of antithrombotic drugs on the risk of first-ever and recurrent macro or micro cerebral haemorrhages, raising the clinical dilemma on the risk/benefit balance of giving antiplatelets and anticoagulants in patients with potential high risk of brain bleeds. High field magnetic resonance imaging (MRI) blood-weighted sequences, including susceptibility weighted imaging (SWI), have expanded the spectrum of these clinical questions, because of their increasing sensitivity in detecting radiological markers of small vessel disease. This review will summarise the literature, focusing on four main clinical questions: how do cerebral microbleeds impact the risk of cerebrovascular events in healthy patients, in patients with previous ischaemic stroke or transient ischaemic attack, and in patients with intracerebral haemorrhage? Is the risk/benefit balance of oral anticoagulants shifted by the presence of microbleeds in patients with atrial fibrillation after recent ischaemic stroke or transient ischaemic attack? Should we restart antiplatelet drugs after symptomatic intracerebral haemorrhage or not? Are oral anticoagulants allowed in patients with a history of atrial fibrillation and previous intracerebral haemorrhage?
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Affiliation(s)
- B Casolla
- University of Lille, Inserm, CHU of Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000 Lille, France.
| | - C Cordonnier
- University of Lille, Inserm, CHU of Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000 Lille, France
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Orchard ER, Ward PGD, Sforazzini F, Storey E, Egan GF, Jamadar SD. Relationship between parenthood and cortical thickness in late adulthood. PLoS One 2020; 15:e0236031. [PMID: 32722686 PMCID: PMC7386609 DOI: 10.1371/journal.pone.0236031] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/26/2020] [Indexed: 11/18/2022] Open
Abstract
Pregnancy and the early postpartum period alter the structure of the brain; particularly in regions related to parental care. However, the enduring effects of this period on human brain structure and cognition in late life is unknown. Here we use magnetic resonance imaging to examine differences in cortical thickness related to parenthood in late life, for both sexes. In 235 healthy older women, we find a positive relationship between parity (number of children parented) and memory performance in mothers. Parity was also associated with differences in cortical thickness in women in the parahippocampus, precuneus, cuneus and pericalcarine sulcus. We also compared non-parents to parents of one child, in a sub-sample of older women (N = 45) and men (N = 35). For females, six regions differed in cortical thickness between parents and non-parents; these regions were consistent with those seen earlier in life in previous studies. For males, five regions differed in cortical thickness between parents and non-parents. We are first to reveal parenthood-related brain differences in late-life; our results are consistent with previously identified areas that are altered during pregnancy and the postpartum period. This study provides preliminary evidence to suggest that neural changes associated with early stages of parenthood persist into older age, and for women, may be related to marginally better cognitive outcomes.
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Affiliation(s)
- Edwina R. Orchard
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Australia
| | - Phillip G. D. Ward
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Australia
| | - Francesco Sforazzini
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Neuroscience (Medicine), Monash University, Alfred Hospital Campus, Melbourne, Victoria, Australia
| | - Gary F. Egan
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Australia
| | - Sharna D. Jamadar
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Australia
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Individual differences in haemoglobin concentration influence bold fMRI functional connectivity and its correlation with cognition. Neuroimage 2020; 221:117196. [PMID: 32721510 PMCID: PMC7994014 DOI: 10.1016/j.neuroimage.2020.117196] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022] Open
Abstract
Resting-state connectivity measures the temporal coherence of the spontaneous neural activity of spatially distinct regions, and is commonly measured using BOLD-fMRI. The BOLD response follows neuronal activity, when changes in the relative concentration of oxygenated and deoxygenated haemoglobin cause fluctuations in the MRI T2* signal. Since the BOLD signal detects changes in relative concentrations of oxy/deoxy-haemoglobin, individual differences in haemoglobin levels may influence the BOLD signal-to-noise ratio in a manner independent of the degree of neural activity. In this study, we examined whether group differences in haemoglobin may confound measures of functional connectivity. We investigated whether relationships between measures of functional connectivity and cognitive performance could be influenced by individual variability in haemoglobin. Finally, we mapped the neuroanatomical distribution of the influence of haemoglobin on functional connectivity to determine where group differences in functional connectivity are manifest. In a cohort of 518 healthy elderly subjects (259 men), each sex group was median-split into two groups with high and low haemoglobin concentration. Significant differences were obtained in functional connectivity between the high and low haemoglobin groups for both men and women (Cohen’s d 0.17 and 0.03 for men and women respectively). The haemoglobin connectome in males showed a widespread systematic increase in functional connectivity correlation values, whilst the female connectome showed predominantly parietal and subcortical increases and temporo-parietal decreases. Despite the haemoglobin groups having no differences in cognitive measures, significant differences in the linear relationships between cognitive performance and functional connectivity were obtained for all 5 cognitive tests in males, and 4 out of 5 tests in females. Our findings confirm that individual variability in haemoglobin levels that give rise to group differences are an important confounding variable in BOLD-fMRI-based studies of functional connectivity. Controlling for haemoglobin variability as a potentially confounding variable is crucial to ensure the reproducibility of human brain connectome studies, especially in studies that compare groups of individuals, compare sexes, or examine connectivity-cognition relationships.
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Doneen AL, Bale BF, Vigerust DJ, Leimgruber PP. Cardiovascular Prevention: Migrating From a Binary to a Ternary Classification. Front Cardiovasc Med 2020; 7:92. [PMID: 32528979 PMCID: PMC7256212 DOI: 10.3389/fcvm.2020.00092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022] Open
Abstract
Migrating from a binary approach to risk assessment to a ternary model of disease identification allows for individualized, optimal disease management. Redefining the disease/inflammatory approach has been proven to identify, stabilize, and regress atherosclerosis while adding understanding to the progression of vascular disease. Our previously published results show the beneficial effect of comprehensive, evidence-based management on subclinical atherosclerosis and vulnerable plaque. We argue that this approach does not mitigate the value of utilizing standard risk factor identification, but rather augments it for the benefit of the individual patient.
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Affiliation(s)
- Amy Lynn Doneen
- College of Medicine, Washington State University, Spokane, WA, United States
| | - Bradley Field Bale
- College of Medicine, Washington State University, Spokane, WA, United States
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21
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Garnier-Crussard A, Desestret V, Cotton F, Chételat G, Krolak-Salmon P. [White matter hyperintensities in ageing: Pathophysiology, associated cognitive disorders and prevention]. Rev Med Interne 2020; 41:475-484. [PMID: 32122680 DOI: 10.1016/j.revmed.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 01/02/2023]
Abstract
White matter hyperintensities (WMH), also known as leukoaraïosis are very common neuroradiological manifestations in the elderly. The main risk factors for WMH are age and high blood pressure. The vascular origin of these lesions is classically accepted and WMH are considered as one feature of the small vessel disease. WMH may be associated with clinical symptoms, depending notably on their importance according to age. They are associated with increased mortality, strokes and changes in cognition with a higher risk of dementia (vascular dementia or Alzheimer's disease). Modification of vascular risk factors could have a beneficial effect, but few evidences from controlled trials are available.
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Affiliation(s)
- A Garnier-Crussard
- Centre mémoire ressource et recherche de Lyon (CMRR), hôpital des Charpennes, institut du vieillissement I-Vie, hospices civils de Lyon, 69002 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Université de Normandie, Unicaen, Inserm, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", institut Blood-and-Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
| | - V Desestret
- Service de neurocognition et de neuro-ophtalmologie, hôpital Pierre-Wertheimer, hospices civils de Lyon, Lyon, France; Institut NeuroMyogène, Inserm U1217/CNRS UMR 5310, université de Lyon - université Claude-Bernard-Lyon 1, Lyon, France; Centre de recherche clinique CRC - VCF (vieillissement-cerveau - fragilité), hôpital des Charpennes, hospices civils de Lyon, 69100 Villeurbanne, France.
| | - F Cotton
- Centre de recherche clinique CRC - VCF (vieillissement-cerveau - fragilité), hôpital des Charpennes, hospices civils de Lyon, 69100 Villeurbanne, France; Service de radiologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, Pierre-Bénite, France; CRÉATIS - CNRS UMR 5220 & Inserm U1044, université Claude-Bernard-Lyon 1, Lyon, France.
| | - G Chételat
- Université de Normandie, Unicaen, Inserm, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", institut Blood-and-Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
| | - P Krolak-Salmon
- Centre mémoire ressource et recherche de Lyon (CMRR), hôpital des Charpennes, institut du vieillissement I-Vie, hospices civils de Lyon, 69002 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Centre de recherche clinique CRC - VCF (vieillissement-cerveau - fragilité), hôpital des Charpennes, hospices civils de Lyon, 69100 Villeurbanne, France.
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22
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Swan D, Loughran N, Makris M, Thachil J. Management of bleeding and procedures in patients on antiplatelet therapy. Blood Rev 2020; 39:100619. [DOI: 10.1016/j.blre.2019.100619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/31/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023]
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23
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Jamadar SD, Sforazzini F, Raniga P, Ferris NJ, Paton B, Bailey MJ, Brodtmann A, Yates PA, Donnan GA, Ward SA, Woods RL, Storey E, McNeil JJ, Egan GF. Sexual Dimorphism of Resting-State Network Connectivity in Healthy Ageing. J Gerontol B Psychol Sci Soc Sci 2019; 74:1121-1131. [PMID: 29471348 PMCID: PMC6748717 DOI: 10.1093/geronb/gby004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/30/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The onset of many illnesses is confounded with age and sex. Increasing age is a risk factor for the development of many illnesses, and sexual dimorphism influences brain anatomy, function, and cognition. Here, we examine frequency-specific connectivity in resting-state networks in a large sample (n = 406) of healthy aged adults. METHOD We quantify frequency-specific connectivity in three resting-state networks known to be implicated in age-related decline: the default mode, dorsal attention, and salience networks, using multiband functional magnetic resonance imaging. Frequency-specific connectivity was quantified in four bands: low (0.015-0.027 Hz), moderately low (0.027-0.073 Hz), moderately high (0.073-0.198 Hz), and high (0.198-0.5 Hz) frequency bands, using mean intensity and spatial extent. Differences in connectivity between the sexes in each of the three networks were examined. RESULTS Each network showed the largest intensity and spatial extent at low frequencies and smallest extent at high frequencies. Males showed greater connectivity than females in the salience network. Females showed greater connectivity than males in the default mode network. DISCUSSION Results in this healthy aged cohort are compatible with those obtained in young samples, suggesting that frequency-specific connectivity, and differences between the sexes, are maintained into older age. Our results indicate that sex should be considered as an influencing factor in studies of resting-state connectivity.
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Affiliation(s)
- Sharna D Jamadar
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
- ARC Centre of Excellence for Integrative Brain Function, Monash University, Clayton, Victoria, Australia
- Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
| | - Francesco Sforazzini
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
- Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
| | - Parnesh Raniga
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
- CSIRO eHealth Research Centre, Herston, Brisbane, Queensland, Australia
| | - Nicholas J Ferris
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Bryan Paton
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael J Bailey
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Behavioural Neuroscience, Florey Institute for Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia
| | - Paul A Yates
- Department of Aged Care Services, Austin Health, Heidelberg, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Monash Ageing Research Centre (MONARC), The Kingston Centre, Cheltenham, Victoria, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Neuroscience (Medicine), Monash University, Alfred Hospital Campus, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
- ARC Centre of Excellence for Integrative Brain Function, Monash University, Clayton, Victoria, Australia
- Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
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24
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Alber J, Alladi S, Bae HJ, Barton DA, Beckett LA, Bell JM, Berman SE, Biessels GJ, Black SE, Bos I, Bowman GL, Brai E, Brickman AM, Callahan BL, Corriveau RA, Fossati S, Gottesman RF, Gustafson DR, Hachinski V, Hayden KM, Helman AM, Hughes TM, Isaacs JD, Jefferson AL, Johnson SC, Kapasi A, Kern S, Kwon JC, Kukolja J, Lee A, Lockhart SN, Murray A, Osborn KE, Power MC, Price BR, Rhodius-Meester HF, Rondeau JA, Rosen AC, Rosene DL, Schneider JA, Scholtzova H, Shaaban CE, Silva NC, Snyder HM, Swardfager W, Troen AM, van Veluw SJ, Vemuri P, Wallin A, Wellington C, Wilcock DM, Xie SX, Hainsworth AH. White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): Knowledge gaps and opportunities. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2019; 5:107-117. [PMID: 31011621 PMCID: PMC6461571 DOI: 10.1016/j.trci.2019.02.001] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
White matter hyperintensities (WMHs) are frequently seen on brain magnetic resonance imaging scans of older people. Usually interpreted clinically as a surrogate for cerebral small vessel disease, WMHs are associated with increased likelihood of cognitive impairment and dementia (including Alzheimer's disease [AD]). WMHs are also seen in cognitively healthy people. In this collaboration of academic, clinical, and pharmaceutical industry perspectives, we identify outstanding questions about WMHs and their relation to cognition, dementia, and AD. What molecular and cellular changes underlie WMHs? What are the neuropathological correlates of WMHs? To what extent are demyelination and inflammation present? Is it helpful to subdivide into periventricular and subcortical WMHs? What do WMHs signify in people diagnosed with AD? What are the risk factors for developing WMHs? What preventive and therapeutic strategies target WMHs? Answering these questions will improve prevention and treatment of WMHs and dementia.
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Affiliation(s)
- Jessica Alber
- Department of Biomedical and Pharmaceutical Sciences, George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hee-Joon Bae
- Cerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - David A. Barton
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Laurel A. Beckett
- Department of Public Health Sciences, School of Medicine University of California, Davis, CA, USA
| | | | - Sara E. Berman
- Wisconsin Alzheimer's Disease Research Center, Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra E. Black
- Department of Medicine, University of Toronto, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Isabelle Bos
- Department of Psychiatry & Neuropsychology, Alzheimer Centre Limburg, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Gene L. Bowman
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Adam M. Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Brandy L. Callahan
- Department of Psychology, University of Calgary & Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Roderick A. Corriveau
- Department of Psychology, University of Calgary & Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Silvia Fossati
- Departments of Neurology and Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Rebecca F. Gottesman
- Division of Cerebrovascular Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deborah R. Gustafson
- Section for NeuroEpidemiology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
| | | | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alex M. Helman
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
| | - Timothy M. Hughes
- Department of Internal Medicine – Section of Gerontology and Geriatric Medicine, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeremy D. Isaacs
- St George's University of London and Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Angela L. Jefferson
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sterling C. Johnson
- Department of Medicine-Geriatrics, Institute on Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - Alifiya Kapasi
- Department of Pathology (Neuropathology), Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - Silke Kern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jay C. Kwon
- Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Athene Lee
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Samuel N. Lockhart
- Department of Internal Medicine – Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anne Murray
- Berman Center for Outcomes and Clinical Research, 20298 Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Katie E. Osborn
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Brittani R. Price
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Hanneke F.M. Rhodius-Meester
- Alzheimer Center, Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Allyson C. Rosen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Douglas L. Rosene
- Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Julie A. Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago IL, USA
| | | | - C. Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health & Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Narlon C.B.S. Silva
- School of Kinesiology, Western Centre for Public Health & Family Medicine, London, ON, Canada
| | - Heather M. Snyder
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Walter Swardfager
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Aron M. Troen
- Institute of Biochemistry Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture Food and Environment, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susanne J. van Veluw
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Anders Wallin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Donna M. Wilcock
- Sanders-Brown Center on Aging, Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Sharon Xiangwen Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Atticus H. Hainsworth
- Molecular & Clinical Sciences Research Institute, St George's University of London and Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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25
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Management of Cerebral Microbleeds in Clinical Practice. Transl Stroke Res 2018; 10:449-457. [DOI: 10.1007/s12975-018-0678-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/28/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022]
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Abstract
This is the first paper in a series of five on how to do good quality clinical research. It sets the scene for the four papers that follow. The aims of the series are to: promote reliable clinical research to inform clinical practice; help people new to research to get started (at any stage of their career); create teaching resources for experienced researchers; and help clinicians working in resource-poor settings to conduct research. We set out in this paper the skills clinicians need to run research projects that are relevant to their clinical practice. We focus on how to get the right training in research methodology, choose and refine a good research question, and then how to ensure the methods and data analysis plan are correct for the question being asked.
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Affiliation(s)
- Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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27
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Aminov A, Rogers JM, Johnstone SJ, Middleton S, Wilson PH. Acute single channel EEG predictors of cognitive function after stroke. PLoS One 2017; 12:e0185841. [PMID: 28968458 PMCID: PMC5624638 DOI: 10.1371/journal.pone.0185841] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 09/20/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early and accurate identification of factors that predict post-stroke cognitive outcome is important to set realistic targets for rehabilitation and to guide patients and their families accordingly. However, behavioral measures of cognition are difficult to obtain in the acute phase of recovery due to clinical factors (e.g. fatigue) and functional barriers (e.g. language deficits). The aim of the current study was to test whether single channel wireless EEG data obtained acutely following stroke could predict longer-term cognitive function. METHODS Resting state Relative Power (RP) of delta, theta, alpha, beta, delta/alpha ratio (DAR), and delta/theta ratio (DTR) were obtained from a single electrode over FP1 in 24 participants within 72 hours of a first-ever stroke. The Montreal Cognitive Assessment (MoCA) was administered at 90-days post-stroke. Correlation and regression analyses were completed to identify relationships between 90-day cognitive function and electrophysiological data, neurological status, and demographic characteristics at admission. RESULTS Four acute qEEG indices demonstrated moderate to high correlations with 90-day MoCA scores: DTR (r = -0.57, p = 0.01), RP theta (r = 0.50, p = 0.01), RP delta (r = -0.47, p = 0.02), and DAR (r = -0.45, p = 0.03). Acute DTR (b = -0.36, p < 0.05) and stroke severity on admission (b = -0.63, p < 0.01) were the best linear combination of predictors of MoCA scores 90-days post-stroke, accounting for 75% of variance. CONCLUSIONS Data generated by a single pre-frontal electrode support the prognostic value of acute DAR, and identify DTR as a potential marker of post-stroke cognitive outcome. Use of single channel recording in an acute clinical setting may provide an efficient and valid predictor of cognitive function after stroke.
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Affiliation(s)
- Anna Aminov
- School of Psychology, Australian Catholic University, Sydney, NSW, Australia
| | | | | | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Australia and Australian Catholic University, Sydney, NSW Australia
| | - Peter H. Wilson
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, VIC, Australia
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28
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Ungvari Z, Tarantini S, Kirkpatrick AC, Csiszar A, Prodan CI. Cerebral microhemorrhages: mechanisms, consequences, and prevention. Am J Physiol Heart Circ Physiol 2017; 312:H1128-H1143. [PMID: 28314762 PMCID: PMC5495931 DOI: 10.1152/ajpheart.00780.2016] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
The increasing prevalence of multifocal cerebral microhemorrhages (CMHs, also known as "cerebral microbleeds") is a significant, newly recognized problem in the aging population of the Western world. CMHs are associated with rupture of small intracerebral vessels and are thought to progressively impair neuronal function, potentially contributing to cognitive decline, geriatric psychiatric syndromes, and gait disorders. Clinical studies show that aging and hypertension significantly increase prevalence of CMHs. CMHs are also now recognized by the National Institutes of Health as a major factor in Alzheimer's disease pathology. Moreover, the presence of CMHs is an independent risk factor for subsequent larger intracerebral hemorrhages. In this article, we review the epidemiology, detection, risk factors, clinical significance, and pathogenesis of CMHs. The potential age-related cellular mechanisms underlying the development of CMHs are discussed, with a focus on the structural determinants of microvascular fragility, age-related alterations in cerebrovascular adaptation to hypertension, the role of oxidative stress and matrix metalloproteinase activation, and the deleterious effects of arterial stiffening, increased pulse pressure, and impaired myogenic autoregulatory protection on the brain microvasculature. Finally, we examine potential treatments for the prevention of CMHs based on the proposed model of aging- and hypertension-dependent activation of the reactive oxygen species-matrix metalloproteinases axis, and we discuss critical questions to be addressed by future studies.
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Affiliation(s)
- Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; .,Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Stefano Tarantini
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Angelia C Kirkpatrick
- Veterans Affairs Medical Center, Oklahoma City, Oklahoma.,Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Calin I Prodan
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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