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Aranha MR, Montal V, van den Brink H, Pegueroles J, Carmona-Iragui M, Videla L, Maure Blesa L, Benejam B, Arranz J, Valldeneu S, Barroeta I, Fernández S, Ribas L, Alcolea D, González-Ortiz S, Bargalló N, Biessels GJ, Blesa R, Lleó A, Coutinho AM, Leite CC, Bejanin A, Fortea J. Cortical microinfarcts in adults with Down syndrome assessed with 3T-MRI. Alzheimers Dement 2024. [PMID: 38644660 DOI: 10.1002/alz.13797] [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: 08/29/2023] [Revised: 02/01/2024] [Accepted: 02/22/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Cortical microinfarcts (CMI) were attributed to cerebrovascular disease and cerebral amyloid angiopathy (CAA). CAA is frequent in Down syndrome (DS) while hypertension is rare, yet no studies have assessed CMI in DS. METHODS We included 195 adults with DS, 63 with symptomatic sporadic Alzheimer's disease (AD), and 106 controls with 3T magnetic resonance imaging. We assessed CMI prevalence in each group and CMI association with age, AD clinical continuum, vascular risk factors, vascular neuroimaging findings, amyloid/tau/neurodegeneration biomarkers, and cognition in DS. RESULTS CMI prevalence was 11.8% in DS, 4.7% in controls, and 17.5% in sporadic AD. In DS, CMI increased in prevalence with age and the AD clinical continuum, was clustered in the parietal lobes, and was associated with lacunes and cortico-subcortical infarcts, but not hemorrhagic lesions. DISCUSSION In DS, CMI are posteriorly distributed and related to ischemic but not hemorrhagic findings suggesting they might be associated with a specific ischemic CAA phenotype. HIGHLIGHTS This is the first study to assess cortical microinfarcts (assessed with 3T magnetic resonance imaging) in adults with Down syndrome (DS). We studied the prevalence of cortical microinfarcts in DS and its relationship with age, the Alzheimer's disease (AD) clinical continuum, vascular risk factors, vascular neuroimaging findings, amyloid/tau/neurodegeneration biomarkers, and cognition. The prevalence of cortical microinfarcts was 11.8% in DS and increased with age and along the AD clinical continuum. Cortical microinfarcts were clustered in the parietal lobes, and were associated with lacunes and cortico-subcortical infarcts, but not hemorrhagic lesions. In DS, cortical microinfarcts are posteriorly distributed and related to ischemic but not hemorrhagic findings suggesting they might be associated with a specific ischemic phenotype of cerebral amyloid angiopathy.
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Affiliation(s)
- Mateus Rozalem Aranha
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
- Laboratory of Nuclear Medicine (LIM 43), Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brasil
- Laboratory of Magnetic Resonance in Neuroradiology (LIM 44), Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brasil
| | - Victor Montal
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
- Barcelona Supercomputing Center, Plaça d'Eusebi Güell, Barcelona, Spain
| | - Hilde van den Brink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jordi Pegueroles
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Maria Carmona-Iragui
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Laura Videla
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Lucia Maure Blesa
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Bessy Benejam
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Javier Arranz
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Sílvia Valldeneu
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Isabel Barroeta
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Laia Ribas
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Daniel Alcolea
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Sofía González-Ortiz
- Hospital del Mar - Parc de Salut Mar, Barcelona, Spain
- Neuroradiology Section, Radiology Department, Diagnostic Image Center, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Núria Bargalló
- Neuroradiology Section, Radiology Department, Diagnostic Image Center, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Magnetic Resonance Image Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rafael Blesa
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Artur Martins Coutinho
- Laboratory of Nuclear Medicine (LIM 43), Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brasil
| | - Cláudia Costa Leite
- Laboratory of Magnetic Resonance in Neuroradiology (LIM 44), Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brasil
| | - Alexandre Bejanin
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
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Nikseresht G, Evia AM, Nag S, Leurgans SE, Capuano AW, Agam G, Barnes LL, Bennett DA, Schneider JA, Arfanakis K. Neuropathologic correlates of cerebral microbleeds in community-based older adults. Neurobiol Aging 2023; 129:89-98. [PMID: 37279617 PMCID: PMC10524842 DOI: 10.1016/j.neurobiolaging.2023.05.005] [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: 01/05/2023] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 06/08/2023]
Abstract
Cerebral microbleeds (CMBs) appearing as hypointense foci on T2*-weighted magnetic resonance images are small hemorrhages that have been linked to cognitive decline and increased mortality. However, the neuropathologic correlates of CMBs in community-based older adults are poorly understood. The present study investigated the association of age-related neuropathologies with CMBs in community-based older adults. Cerebral hemispheres from 289 participants of the Rush Memory and Aging Project, Religious Orders Study, Minority Aging Research Study, and Rush Alzheimer's Disease Clinical Core underwent ex vivo MRI and detailed neuropathologic examination. Following Bonferroni correction, CMBs in the cerebrum overall and in the frontal lobe were associated with cerebral amyloid angiopathy, CMBs in the frontal lobe were also associated with arteriolosclerosis, and CMBs in the basal ganglia showed a borderline significant association with microinfarcts. These findings suggest that CMBs can aid in the prediction of small vessel disease in community-based older adults. Finally, CMBs were not associated with dementia, suggesting that CMBs in community-based older adults may not be linked to substantial cognitive impairment.
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Affiliation(s)
- Grant Nikseresht
- Department of Computer Science, Illinois Institute of Technology, Chicago, IL, USA; Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Arnold M Evia
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Sukriti Nag
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Ana W Capuano
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Gady Agam
- Department of Computer Science, Illinois Institute of Technology, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Konstantinos Arfanakis
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL, USA.
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Theodorou A, Palaiodimou L, Papagiannopoulou G, Kargiotis O, Psychogios K, Safouris A, Bakola E, Chondrogianni M, Kotsali-Peteinelli V, Melanis K, Tsibonakis A, Andreadou E, Vasilopoulou S, Lachanis S, Velonakis G, Tzavellas E, Tzartos JS, Voumvourakis K, Paraskevas GP, Tsivgoulis G. Clinical Characteristics, Neuroimaging Markers, and Outcomes in Patients with Cerebral Amyloid Angiopathy: A Prospective Cohort Study. J Clin Med 2023; 12:5591. [PMID: 37685658 PMCID: PMC10488273 DOI: 10.3390/jcm12175591] [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: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Background and purpose: Sporadic cerebral amyloid angiopathy (CAA) is a small vessel disease, resulting from progressive amyloid-β deposition in the media/adventitia of cortical and leptomeningeal arterioles. We sought to assess the prevalence of baseline characteristics, clinical and radiological findings, as well as outcomes among patients with CAA, in the largest study to date conducted in Greece. Methods: Sixty-eight patients fulfilling the Boston Criteria v1.5 for probable/possible CAA were enrolled and followed for at least twelve months. Magnetic Resonance Imaging was used to assess specific neuroimaging markers. Data regarding cerebrospinal fluid biomarker profile and Apolipoprotein-E genotype were collected. Multiple logistic regression analyses were performed to identify predictors of clinical phenotypes. Cox-proportional hazard regression models were used to calculate associations with the risk of recurrent intracerebral hemorrhage (ICH). Results: Focal neurological deficits (75%), cognitive decline (57%), and transient focal neurological episodes (TFNEs; 21%) were the most common clinical manifestations. Hemorrhagic lesions, including lobar cerebral microbleeds (CMBs; 93%), cortical superficial siderosis (cSS; 48%), and lobar ICH (43%) were the most prevalent neuroimaging findings. cSS was independently associated with the likelihood of TFNEs at presentation (OR: 4.504, 95%CI:1.258-19.088), while multiple (>10) lobar CMBs were independently associated with cognitive decline at presentation (OR:5.418, 95%CI:1.316-28.497). cSS emerged as the only risk factor of recurrent ICH (HR:4.238, 95%CI:1.509-11.900) during a median follow-up of 20 months. Conclusions: cSS was independently associated with TFNEs at presentation and ICH recurrence at follow-up, while a higher burden of lobar CMBs with cognitive decline at baseline. These findings highlight the prognostic value of neuroimaging markers, which may influence clinical decision-making.
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Affiliation(s)
- Aikaterini Theodorou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Georgia Papagiannopoulou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Odysseas Kargiotis
- Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (O.K.); (K.P.); (A.S.)
| | - Klearchos Psychogios
- Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (O.K.); (K.P.); (A.S.)
| | - Apostolos Safouris
- Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (O.K.); (K.P.); (A.S.)
| | - Eleni Bakola
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Maria Chondrogianni
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Vasiliki Kotsali-Peteinelli
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Konstantinos Melanis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Athanasios Tsibonakis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Elissavet Andreadou
- First Department of Neurology, “Eginition” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (S.V.)
| | - Sofia Vasilopoulou
- First Department of Neurology, “Eginition” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (S.V.)
| | - Stefanos Lachanis
- Iatropolis Magnetic Resonance Diagnostic Centre, 15231 Athens, Greece;
| | - Georgios Velonakis
- Second Department of Radiology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Elias Tzavellas
- First Department of Psychiatry, “Aiginition” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - John S. Tzartos
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Konstantinos Voumvourakis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Georgios P. Paraskevas
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Jang H, Chun MY, Kim HJ, Na DL, Seo SW. The effects of imaging markers on clinical trajectory in cerebral amyloid angiopathy: a longitudinal study in a memory clinic. Alzheimers Res Ther 2023; 15:14. [PMID: 36635759 PMCID: PMC9835259 DOI: 10.1186/s13195-023-01161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND We investigated the relevance of various imaging markers for the clinical trajectory of cerebral amyloid angiopathy (CAA) patients in a memory clinic. METHODS A total of 226 patients with probable CAA were included in this study with a mean follow-up period of 3.5 ± 2.7 years. Although all had more than one follow-up visit, 173 underwent follow-up Mini-Mental Status Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SB) ranging from 2 to 15 time points. Among 226, 122 patients underwent amyloid-β (Aβ) PET imaging. The prevalence of intracerebral hemorrhage (ICH) and its imaging predictors was investigated. The effects of CAA imaging markers and Aβ PET positivity on longitudinal cognition based on the MMSE and CDR-SB were evaluated using mixed effects models. RESULTS During the follow-up, 10 (4.4%) patients developed ICH: cortical superficial siderosis (cSS; hazard ratio [HR], 6.45) and previous lobar ICH (HR, 4.9), but lobar cerebral microbleeds (CMBs) were not predictors of ICH development. The presence of CMIs (p = 0.045) and Aβ positivity (p = 0.002) were associated with worse MMSE trajectory in CAA patients. Regarding CDR-SB trajectory, only Aβ positivity was marginally associated with worse longitudinal change (p = 0.050). CONCLUSION The results of the present study indicated that various imaging markers in CAA patients have different clinical relevance and predictive values for further clinical courses.
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Affiliation(s)
- Hyemin Jang
- grid.414964.a0000 0001 0640 5613Samsung Alzheimer’s Convergence Research Center, Samsung Medical Center, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Min Young Chun
- grid.264381.a0000 0001 2181 989XDepartments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Hee Jin Kim
- grid.264381.a0000 0001 2181 989XDepartments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Duk L. Na
- grid.264381.a0000 0001 2181 989XDepartments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea ,Happymind Clinic, Seoul, South Korea
| | - Sang Won Seo
- grid.414964.a0000 0001 0640 5613Samsung Alzheimer’s Convergence Research Center, Samsung Medical Center, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
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Ramaswamy S, Khasiyev F, Gutierrez J. Brain Enlarged Perivascular Spaces as Imaging Biomarkers of Cerebrovascular Disease: A Clinical Narrative Review. J Am Heart Assoc 2022; 11:e026601. [PMID: 36533613 PMCID: PMC9798817 DOI: 10.1161/jaha.122.026601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Perivascular spaces or Virchow-Robin spaces form pathways along the subarachnoid spaces that facilitate the effective clearance of brain metabolic by-products through intracellular exchange and drainage of cerebrospinal fluid. Best seen on magnetic resonance imaging of the brain, enlarged perivascular spaces (EPVSs) are increasingly recognized as potential imaging biomarkers of neurological conditions. EPVSs are an established subtype of cerebral small-vessel disease; however, their associations with other cerebrovascular disorders are yet to be fully understood. In particular, there has been great interest in the association between the various parameters of EPVSs, such as number, size, and topography, and vascular neurological conditions. Studies have identified cross-sectional and longitudinal relationships between EPVS parameters and vascular events, such as ischemic stroke (both clinical and silent), intracerebral hemorrhage, vascular risk factors, such as age and hypertension, and neurodegenerative processes, such as vascular dementia and Alzheimer disease. However, these studies are limited by heterogeneity of data and the lack of consistent results across studied populations. Existing meta-analyses also fail to provide uniformity of results. We performed a qualitative narrative review with an aim to provide an overview of the associations between EPVSs and cerebrovascular diseases, which may help recognize gaps in our knowledge, inform the design of future studies, and advance the role of EPVSs as imaging biomarkers.
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Affiliation(s)
- Srinath Ramaswamy
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNY
| | - Farid Khasiyev
- Department of NeurologySt. Louis University School of MedicineSt. LouisMO
| | - Jose Gutierrez
- Department of NeurologyColumbia University Irving Medical CenterNew YorkNY
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Yang J, Jing J, Chen S, Liu X, Tang Y, Pan C, Tang Z. Changes in Cerebral Blood Flow and Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage. Transl Stroke Res 2022; 13:686-706. [PMID: 35305264 DOI: 10.1007/s12975-022-00998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
Abstract
Intracerebral hemorrhage (ICH) is a common subtype of stroke and places a great burden on the family and society with a high mortality and disability rate and a poor prognosis. Many findings from imaging and pathologic studies have suggested that cerebral ischemic lesions visualized on diffusion-weighted imaging (DWI) in patients with ICH are not rare and are generally considered to be associated with poor outcome, increased risk of recurrent (ischemic and hemorrhagic) stroke, cognitive impairment, and death. In this review, we describe the changes in cerebral blood flow (CBF) and DWI lesions after ICH and discuss the risk factors and possible mechanisms related to the occurrence of DWI lesions, such as cerebral microangiopathy, cerebral atherosclerosis, aggressive early blood pressure lowering, hyperglycemia, and inflammatory response. We also point out that a better understanding of cerebral DWI lesions will be a key step toward potential therapeutic interventions to improve long-term recovery for patients with ICH.
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Affiliation(s)
- Jingfei Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Jie Jing
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Xia Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Yingxin Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China.
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China.
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Malhotra K, Theodorou A, Katsanos AH, Zompola C, Shoamanesh A, Boviatsis E, Paraskevas GP, Spilioti M, Cordonnier C, Werring DJ, Alexandrov AV, Tsivgoulis G. Prevalence of Clinical and Neuroimaging Markers in Cerebral Amyloid Angiopathy: A Systematic Review and Meta-Analysis. Stroke 2022; 53:1944-1953. [PMID: 35264008 DOI: 10.1161/strokeaha.121.035836] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist regarding the prevalence of clinical and neuroimaging manifestations among patients diagnosed with cerebral amyloid angiopathy (CAA). We sought to determine the prevalence of clinical phenotypes and radiological markers in patients with CAA. METHODS Systematic review and meta-analysis of studies including patients with CAA was conducted to primarily assess the prevalence of clinical phenotypes and neuroimaging markers as available in the included studies. Sensitivity analyses were performed based on the (1) retrospective or prospective study design and (2) probable or unspecified CAA status. We pooled the prevalence rates using random-effects models and assessed the heterogeneity using the Cochran Q and I2 statistics. RESULTS We identified 12 prospective and 34 retrospective studies including 7159 patients with CAA. The pooled prevalence rates were cerebral microbleeds (52% [95% CI, 43%-60%]; I2=93%), cortical superficial siderosis (49% [95% CI, 38%-59%]; I2=95%), dementia or mild cognitive impairment (50% [95% CI, 35%-65%]; I2=97%), intracerebral hemorrhage (ICH; 44% [95% CI, 27%-61%]; I2=98%), transient focal neurological episodes (48%; 10 studies [95% CI, 29%-67%]; I2=97%), lacunar infarcts (30% [95% CI, 25%-36%]; I2=78%), high grades of perivascular spaces located in centrum semiovale (56% [95% CI, 44%-67%]; I2=88%) and basal ganglia (21% [95% CI, 2%-51%]; I2=98%), and white matter hyperintensities with moderate or severe Fazekas score (53% [95% CI, 40%-65%]; I2=91%). The only neuroimaging marker that was associated with higher odds of recurrent ICH was cortical superficial siderosis (odds ratio, 1.57 [95% CI, 1.01-2.46]; I2=47%). Sensitivity analyses demonstrated a higher prevalence of ICH (53% versus 16%; P=0.03) and transient focal neurological episodes (57% versus 17%; P=0.03) among retrospective studies compared with prospective studies. No difference was documented between the prevalence rates based on the CAA status. CONCLUSIONS Approximately one-half of hospital-based cohort of CAA patients was observed to have cerebral microbleeds, cortical superficial siderosis, mild cognitive impairment, dementia, ICH, or transient focal neurological episodes. Cortical superficial siderosis was the only neuroimaging marker that was associated with higher odds of ICH recurrence. Future population-based studies among well-defined CAA cohorts are warranted to corroborate our findings.
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Affiliation(s)
- Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Aikaterini Theodorou
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.)
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.).,Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S.)
| | - Christina Zompola
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.)
| | - Ashkan Shoamanesh
- Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S.)
| | - Efstathios Boviatsis
- Department of Neurosurgery, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (E.B.)
| | - George P Paraskevas
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.)
| | - Martha Spilioti
- First Department of Neurology, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece (M.S.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience and Cognition, France (C.C.)
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W.)
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.).,Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G.T.)
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8
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Bourhis-Guizien F, Dissaux B, Boulouis G, Ben Salem D, Gentric JC, Ognard J. The Combination of Stent and Antiplatelet Therapy May Be Responsible of Parenchymal Magnetic Susceptibility Artifacts after Endovascular Procedure. Tomography 2021; 7:792-800. [PMID: 34842852 PMCID: PMC8628901 DOI: 10.3390/tomography7040066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
The aim was to assess the occurrence of magnetic susceptibility artifacts (MSA) following endovascular treatment of intracranial aneurysm by stent using susceptibility weighted imaging (SWI). Imaging and clinical data of 46 patients who underwent stent placement in the case of intracranial aneurysm endovascular treatment (S-Group) were retrospectively analyzed and compared to a control group (C-Group) in which 46 patients had coiling alone. The mean number of MSA was higher in the S-group than in the C-group on postprocedural SWI sequence (8.76, 95%CI [5.76; 11.76] vs. 0.78 [0.32; 1.25], respectively, p < 0.001) with a higher frequency of the appearance of MSA also in the S-group (78.26% vs. 21.74% in the C-group, p < 0.001). In the S-group, in the vascular territory of the treated artery, there was a higher number of MSA than in other vascular territories (mean of 5.18 [3.43; 6.92] vs. 3.08 [1.79; 4.36], p = 0.001). An odds ratio (OR) of 20.98 [5.24; 83.95] suggested a higher proportion of onset of MSA in the S-group than in the C-group (p < 0.001). The appearance of MSA after a treatment by stenting for intracranial aneurysm in patients under antiplatelet therapy was common, particularly in the treated artery territory.
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Affiliation(s)
- Fanny Bourhis-Guizien
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
| | - Brieg Dissaux
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Western Brittany Thrombosis Study Group GETBO EA3878, 29609 Brest, France
| | - Grégoire Boulouis
- Neuroradiology Unit, Department of Radiology, Saint-Anne Hospital, INSERM UMR 894, 75674 Paris, France;
| | - Douraied Ben Salem
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Laboratory of Medical Information Processing, LaTIM INSERM UMR 1101, 29200 Brest, France
| | - Jean-Christophe Gentric
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Western Brittany Thrombosis Study Group GETBO EA3878, 29609 Brest, France
| | - Julien Ognard
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Laboratory of Medical Information Processing, LaTIM INSERM UMR 1101, 29200 Brest, France
- Correspondence:
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9
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Zwartbol MH, Rissanen I, Ghaznawi R, de Bresser J, Kuijf HJ, Blom K, Witkamp TD, Koek HL, Biessels GJ, Hendrikse J, Geerlings MI. Cortical cerebral microinfarcts on 7T MRI: Risk factors, neuroimaging correlates and cognitive functioning - The Medea-7T study. J Cereb Blood Flow Metab 2021; 41:3127-3138. [PMID: 34187229 PMCID: PMC8543666 DOI: 10.1177/0271678x211025447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We determined the occurrence and association of cortical cerebral microinfarcts (CMIs) at 7 T MRI with risk factors, neuroimaging markers of small and large vessel disease, and cognitive functioning. Within the Medea-7T study, a diverse cohort of older persons with normal cognition, patients with vascular disease, and memory clinic patients, we included 386 participants (68 ± 9 years) with available 7 T and 1.5 T/3T brain MRI, and risk factor and neuropsychological data. CMIs were found in 10% of participants and were associated with older age (RR = 1.79 per +10 years, 95%CI 1.28-2.50), history of stroke or TIA (RR = 4.03, 95%CI 2.18-7.43), cortical infarcts (RR = 5.28, 95%CI 2.91-9.55), lacunes (RR = 5.66, 95%CI 2.85-11.27), cerebellar infarcts (RR = 2.73, 95%CI 1.27-5.84) and decreased cerebral blood flow (RR = 1.35 per -100 ml/min, 95%CI 1.00-1.83), after adjustment for age and sex. Furthermore, participants with >2 CMIs had 0.5 SD (95%CI 0.05-0.91) lower global cognitive performance, compared to participants without CMIs. Our results indicate that CMIs on 7 T MRI are observed in vascular and memory clinic patients with similar frequency, and are associated with older age, history of stroke or TIA, other brain infarcts, and poorer global cognitive functioning.
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Affiliation(s)
- Maarten Ht Zwartbol
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Rashid Ghaznawi
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kim Blom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Theo D Witkamp
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Huiberdina L Koek
- Department of Geriatrics, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
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10
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McNally JS, Sakata A, Alexander MD, Dewitt LD, Sonnen JA, Menacho ST, Stoddard GJ, Kim SE, de Havenon AH. Vessel Wall Enhancement on Black-Blood MRI Predicts Acute and Future Stroke in Cerebral Amyloid Angiopathy. AJNR Am J Neuroradiol 2021; 42:1038-1045. [PMID: 33737266 PMCID: PMC8191668 DOI: 10.3174/ajnr.a7047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/11/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral amyloid angiopathy (CAA) is a known risk factor for ischemic stroke though angiographic imaging is often negative. Our goal was to determine the relationship between vessel wall enhancement (VWE) in acute and future ischemic stroke in CAA patients. MATERIALS AND METHODS This was a retrospective study of patients with new-onset neurologic symptoms undergoing 3T vessel wall MR imaging from 2015 to 2019. Vessel wall enhancement was detected on pre- and postcontrast flow-suppressed 3D T1WI. Interrater agreement was evaluated in cerebral amyloid angiopathy-positive and age-matched negative participants using a prevalence- and bias-adjusted kappa analysis. In patients with cerebral amyloid angiopathy, multivariable Poisson and Cox regression were used to determine the association of vessel wall enhancement with acute and future ischemic stroke, respectively, using backward elimination of confounders to P < .20. RESULTS Fifty patients with cerebral amyloid angiopathy underwent vessel wall MR imaging, including 35/50 (70.0%) with ischemic stroke and 29/50 (58.0%) with vessel wall enhancement. Prevalence- and bias-corrected kappa was 0.82 (95% CI, 0.71-0.93). The final regression model for acute ischemic stroke included vessel wall enhancement (prevalence ratio = 1.5; 95% CI, 1.1-2.2; P = .022), age (prevalence ratio = 1.02; 95% CI, 1.0-1.05; P = .036), time between symptoms and MR imaging (prevalence ratio = 0.9; 95% CI, 0.8-0.9; P < .001), and smoking (prevalence ratio = 0.7; 95% CI, 0.5-1.0; P = .042) with c-statistic = 0.92 (95% CI, 0.84-0.99). Future ischemic stroke incidence with cerebral amyloid angiopathy was 49.7% (95% CI, 34.5%-67.2%) per year over a total time at risk of 37.5 person-years. Vessel wall enhancement-positive patients with cerebral amyloid angiopathy demonstrated significantly shorter stroke-free survival with 63.9% (95% CI, 43.2%-84.0%) versus 32.2% (95% CI, 14.4%-62.3%) ischemic strokes per year, chi-square = 4.9, P = .027. The final model for future ischemic stroke had a c-statistic of 0.70 and included initial ischemic stroke (hazard ratio = 3.4; 95% CI, 1.0-12.0; P = .053) and vessel wall enhancement (hazard ratio = 2.5; 95% CI, 0.9-7.0; P = .080). CONCLUSIONS Vessel wall enhancement is associated with both acute and future stroke in patients with cerebral amyloid angiopathy.
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Affiliation(s)
- J S McNally
- From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah
| | - A Sakata
- From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah
| | - M D Alexander
- From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah
| | - L D Dewitt
- Department of Pathology (J.A.S.), University of Utah, Salt Lake City, Utah
| | - J A Sonnen
- Department of Pathology (J.A.S.), University of Utah, Salt Lake City, Utah
| | - S T Menacho
- Department of Neurosurgery (S.T.M.), University of Utah, Salt Lake City, Utah
| | - G J Stoddard
- Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City, Utah
| | - S-E Kim
- From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah
| | - A H de Havenon
- Department of Neurology (L.D.D., A.H.d.H.), University of Utah, Salt Lake City, Utah
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11
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Cerebral microbleeds in vascular dementia from clinical aspects to host-microbial interaction. Neurochem Int 2021; 148:105073. [PMID: 34048844 DOI: 10.1016/j.neuint.2021.105073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 12/30/2022]
Abstract
Vascular dementia is the second leading cause of dementia after Alzheimer's disease in the elderly population worldwide. Cerebral microbleeds (CMBs) are frequently observed in MRI of elderly subjects and considered as a possible surrogate marker. The number and location of CMBs reflect the severity of diseases and the underlying pathologies may involve cerebral amyloid angiopathy or hypertensive vasculopathy. Accumulating evidence demonstrated the clinicopathological discrepancies of CMBs, the clinical significance of CMBs associated with other MRI markers of cerebral small vessel disease, cognitive impairments, serum, and cerebrospinal fluid biomarkers. Moreover, emerging evidence has shown that genetic factors and gene-environmental interactions might shed light on the underlying etiologies of CMBs, focusing on blood-brain-barrier and inflammation. In this review, we introduce recent genetic and microbiome studies as a cutting-edge approach to figure out the etiology of CMBs through the "microbe-brain-oral axis" and "microbiome-brain-gut axis." Finally, we propose novel concepts, "microvascular matrisome" and "imbalanced proteostasis," which may provide better perspectives for elucidating the pathophysiology of CMBs and future development of therapeutics for vascular dementia using CMBs as a surrogate marker.
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12
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Novosadova OA, Semenova TN, Grigoryeva VN. [Cerebral amyloid angiopathy, comorbid atrial fibrillation]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:46-52. [PMID: 33908232 DOI: 10.17116/jnevro202112103246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is caused by the deposition of β-amyloid in small vessels in the cerebral cortex and leptomeninges. Nowadays, CAA is recognized more often due to the development of neuroimaging technologies. The frequency of CAA increases in old age that explains its frequent association with cardiovascular diseases. Combination of CAA with atrial fibrillation (AF) causes particular difficulties in managing of the patients, since antithrombotic drugs prescribed to patients with AF mostly contraindicated in CAA because of increased risk of intracerebral hemorrhages. The article presents a case report of the patient with AF who was admitted to the stroke center with acute ischemic stroke. According to MRI, the focus of acute ischemia was small and localized in the cerebellum. This stroke was regarded as having an undetermined etiology according TOAST classification. Small-vessel occlusion subtype was not diagnosed because the TOAST criteria do not attribute an ischemic focus in the cerebellum to a lacunar stroke, while cardioembolic subtype was rejected due to a small (less than 1.5 cm in diameter) size of the focus. Probable CAA in the patient was diagnosed on the basis of the following MRI data: multiple cortical-subcortical micro-hemorrhages (T2*GRE); a single cortical focus with features of the hemorrhage at the stage of intracellular methemoglobin deposition (T1- weighted MR images); bilateral enlargement of perivascular spaces in semioval centers (FLAIR); a negative fronto-occipital gradient (T2-weighted MR images). A diagnosis of CAA was made in accordance with the 2010 Boston criteria and 2019 recommendations of the International CAA Association. The article discusses the hemorrhagic and non-hemorrhagic MRI features of CAA. Frequency of occurrence of cortical microinfarcts in CAA is discussed as well as their differences from small cardioembolic infarcts in AF. Algorithms for antithrombotic therapy for secondary prevention of ischemic stroke in patients with CAA and AF are considered.
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Affiliation(s)
- O A Novosadova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - T N Semenova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - V N Grigoryeva
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
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13
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Gokcal E, Horn MJ, van Veluw SJ, Frau-Pascual A, Das AS, Pasi M, Fotiadis P, Warren AD, Schwab K, Rosand J, Viswanathan A, Polimeni JR, Greenberg SM, Gurol ME. Lacunes, Microinfarcts, and Vascular Dysfunction in Cerebral Amyloid Angiopathy. Neurology 2021; 96:e1646-e1654. [PMID: 33536272 PMCID: PMC8032369 DOI: 10.1212/wnl.0000000000011631] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/18/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To analyze the relationship of lacunes with cortical cerebral microinfarcts (CMIs), to assess their association with vascular dysfunction, and to evaluate their effect on the risk of incident intracerebral hemorrhage (ICH) in cerebral amyloid angiopathy (CAA). METHODS The count and topography of lacunes (deep/lobar), CMIs, and white matter hyperintensity (WMH) volume were retrospectively analyzed in a prospectively enrolled CAA cohort that underwent high-resolution research MRIs. The relationship of lacunes with CMIs and other CAA-related markers including time to peak (TTP) of blood oxygen level-dependent signal, an established measure of vascular dysfunction, was evaluated in multivariate models. Adjusted Cox regression models were used to investigate the relationship between lacunes and incident ICH. RESULTS The cohort consisted of 122 patients with probable CAA without dementia (mean age, 69.4 ± 7.6 years). Lacunes were present in 31 patients (25.4%); all but one were located in lobar regions. Cortical CMIs were more common in patients with lacunes compared to patients without lacunes (51.6% vs 20.9%, p = 0.002). TTP was not associated with either lacunes or CMIs (both p > 0.2) but longer TTP response independently correlated with higher WMH volume (p = 0.001). Lacunes were associated with increased ICH risk in univariate and multivariate Cox regression models (p = 0.048 and p = 0.026, respectively). CONCLUSIONS Our findings show a high prevalence of lobar lacunes, frequently coexisting with CMIs in CAA, suggesting that these 2 lesion types may be part of a common spectrum of CAA-related infarcts. Lacunes were not related to vascular dysfunction but predicted incident ICH, favoring severe focal vessel involvement rather than global ischemia as their mechanism.
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Affiliation(s)
- Elif Gokcal
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Mitchell J Horn
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Susanne J van Veluw
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Aina Frau-Pascual
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Alvin S Das
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Marco Pasi
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Panagiotis Fotiadis
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Andrew D Warren
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Kristin Schwab
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Jonathan Rosand
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Anand Viswanathan
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Jonathan R Polimeni
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - Steven M Greenberg
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France
| | - M Edip Gurol
- From the J. Philip Kistler Hemorrhagic Stroke Research Program, Department of Neurology (E.G., M.J.H., S.J.v.V., M.P., P.F., A.D.W., K.S., J.R., A.V., S.M.G., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A.F.-P., J.R.P.), Charlestown; Department of Neurology (A.S.D.), Massachusetts General Hospital, Boston; and Department of Neurology, Stroke Unit (M.P.), Univ-Lille, Inserm U1171, CHU Lille, France.
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14
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Ii Y, Ishikawa H, Shindo A, Matsuyama H, Matsuura K, Matsuda K, Yoshimaru K, Satoh M, Kogue R, Umino M, Maeda M, Tomimoto H. Association between cortical microinfarcts and total small vessel disease burden in cerebral amyloid angiopathy on 3-Tesla magnetic resonance imaging. Eur J Neurol 2020; 28:794-799. [PMID: 33098163 DOI: 10.1111/ene.14610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Cortical microinfarcts (CMIs) are frequently found in the brains of patients with advanced cerebral amyloid angiopathy (CAA) at autopsy. The small vessel disease (SVD) score for CAA (i.e., the CAA-SVD score) has been proposed to evaluate the severity of CAA-associated vasculopathic changes by a combination of magnetic resonance imaging (MRI) markers. The aim of this study was to examine the association between total CAA-SVD score and features of CMIs on in vivo 3-Tesla MRI. METHODS Eighty patients with probable CAA were retrospectively analyzed. Lobar cerebral microbleeds, cortical superficial siderosis, enlargement of perivascular space in the centrum semiovale and white matter hyperintensity were collectively assessed, and the total CAA-SVD score was calculated. The presence of CMI was also examined. RESULTS Of the 80 patients, 13 (16.25%) had CMIs. CMIs were detected more frequently in the parietal and occipital lobes. A positive correlation was found between total CAA-SVD score and prevalence of CMI (ρ = 0.943; p = 0.005). Total CAA-SVD score was significantly higher in patients with CMIs than in those without (p = 0.009). In a multivariable logistic regression analysis, the presence of CMIs was significantly associated with total CAA-SVD score (odds ratio 2.318 [95% confidence interval 1.228-4.376]; p = 0.01, per each additional point). CONCLUSIONS The presence of CMIs with a high CAA-SVD score could be an indicator of more severe amyloid-associated vasculopathic changes in patients with probable CAA.
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Affiliation(s)
- Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kana Matsuda
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kimiko Yoshimaru
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Ryota Kogue
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Maki Umino
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
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15
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Abstract
With age, the presence of multiple neuropathologies in a single individual becomes increasingly common. Given that traumatic brain injury and the repetitive head impacts (RHIs) that occur in contact sports have been associated with the development of many neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), Alzheimer's disease, Lewy body disease, and amyotrophic lateral sclerosis, it is becoming critical to understand the relationship and interactions between these pathologies. In fact, comorbid pathology is common in CTE and likely influenced by both age and the severity and type of exposure to RHI as well as underlying genetic predisposition. Here, we review the major comorbid pathologies seen with CTE and in former contact sports athletes and discuss what is known about the associations between RHI, age, and the development of neuropathologies. In addition, we examine the distinction between CTE and age-related pathology including primary age-related tauopathy and age-related tau astrogliopathy.
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Affiliation(s)
- Thor D. Stein
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts,Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts,Departments of Research and Pathology & Laboratory Medicine, VA Boston Healthcare System, Boston, Massachusetts,Department of Veterans Affairs Medical Center, Bedford, Massachusetts
| | - John F. Crary
- Department of Pathology, Neuropathology Brain Bank & Research Core, Ronald M. Loeb Center for Alzheimer’s Disease, Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York
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16
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Wadi LC, Grigoryan MM, Kim RC, Fang C, Kim J, Corrada MM, Paganini-Hill A, Fisher MJ. Mechanisms of Cerebral Microbleeds. J Neuropathol Exp Neurol 2020; 42:1093-1099. [PMID: 32930790 DOI: 10.1093/jnen/nlaa082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/01/2020] [Indexed: 01/01/2023] Open
Abstract
Cerebral microbleeds (CMB) are a common MRI finding, representing underlying cerebral microhemorrhages (CMH). The etiology of CMB and microhemorrhages is obscure. We conducted a pathological investigation of CMH, combining standard and immunohistological analyses of postmortem human brains. We analyzed 5 brain regions (middle frontal gyrus, occipital pole, rostral cingulate cortex, caudal cingulate cortex, and basal ganglia) of 76 brain bank subjects (mean age ± SE 90 ± 1.4 years). Prussian blue positivity, used as an index of CMH, was subjected to quantitative analysis for all 5 brain regions. Brains from the top and bottom quartiles (n = 19 each) were compared for quantitative immunohistological findings of smooth muscle actin, claudin-5, and fibrinogen, and for Sclerosis Index (SI) (a measure of arteriolar remodeling). Brains in the top quartile (i.e. with most extensive CMH) had significantly higher SI in the 5 brain regions combined (0.379 ± 0.007 vs 0.355 ± 0.008; p < 0.05). These findings indicate significant coexistence of arteriolar remodeling with CMH. While these findings provide clues to mechanisms of microhemorrhage development, further studies of experimental neuropathology are needed to determine causal relationships.
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Affiliation(s)
- Lara C Wadi
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Mher Mahoney Grigoryan
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Ronald C Kim
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Chuo Fang
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Jeffrey Kim
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - María M Corrada
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Annlia Paganini-Hill
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
| | - Mark J Fisher
- From the Department of Neurology (LCW, MMG, CF, MMC, AP-H, MJF); Department of Pathology & Laboratory Medicine (RCK, JK); and Department of Epidemiology and Institute for Memory Impairments and Neurological Disorders (MMC), University of California, Irvine, California
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17
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Association of Ultrasonography and MRI Findings with Stroke Recurrence: Differences Between Patients with Past Histories of Atherothrombotic Versus Lacunar Infarctions. J Stroke Cerebrovasc Dis 2019; 28:104391. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/11/2019] [Accepted: 08/31/2019] [Indexed: 11/22/2022] Open
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18
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Xiong L, van Veluw SJ, Bounemia N, Charidimou A, Pasi M, Boulouis G, Reijmer YD, Giese AK, Davidsdottir S, Fotiadis P, Valenti R, Riley G, Schwab K, Gurol EM, Biffi A, Greenberg SM, Viswanathan A. Cerebral Cortical Microinfarcts on Magnetic Resonance Imaging and Their Association With Cognition in Cerebral Amyloid Angiopathy. Stroke 2019; 49:2330-2336. [PMID: 30355109 DOI: 10.1161/strokeaha.118.022280] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to explore the association between presence of cerebral cortical microinfarcts (CMIs) on magnetic resonance imaging and other small-vessel disease neuroimaging biomarkers in cerebral amyloid angiopathy (CAA) and to analyze the role of CMIs on individual cognitive domains and dementia conversion. Methods- Participants were recruited from an ongoing longitudinal research cohort of eligible CAA patients between March 2006 and October 2016. A total of 102 cases were included in the analysis that assessed the relationship of cortical CMIs to CAA neuroimaging markers. Ninety-five subjects had neuropsychological tests conducted within 1 month of magnetic resonance imaging scanning. Seventy-five nondemented CAA patients had cognitive evaluation data available during follow-up. Results- Among 102 patients enrolled, 40 patients had CMIs (39%) on magnetic resonance imaging. CMIs were uniformly distributed throughout the cortex without regional predilection ( P=0.971). The presence of CMIs was associated with lower total brain volume (odds ratio, 0.85; 95% CI, 0.74-0.98; P=0.025) and presence of cortical superficial siderosis (odds ratio, 2.66; 95% CI, 1.10-6.39; P=0.029). In 95 subjects with neuropsychological tests, presence of CMIs was associated with impaired executive function (β, -0.23; 95% CI, -0.44 to -0.02; P=0.036) and processing speed (β, -0.24; 95% CI, -0.45 to -0.04; P=0.020). Patients with CMIs had a higher cumulative dementia incidence compared with patients without CMIs ( P=0.043), whereas only baseline total brain volume (hazard ratio, 0.76; 95% CI, 0.62-0.92; P=0.006) independently predicted dementia conversion. Conclusions- Magnetic resonance imaging-detected CMIs in CAA correlated with greater overall disease burden. The presence of CMIs was associated with worse cognitive performance, whereas only total brain atrophy independently predicted dementia conversion.
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Affiliation(s)
- Li Xiong
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Susanne J van Veluw
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Narimene Bounemia
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Andreas Charidimou
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Marco Pasi
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Gregoire Boulouis
- Centre Hospitalier Sainte-Anne, Université Paris Descartes, France (G.B.)
| | - Yael D Reijmer
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (Y.D.R.)
| | - Anne-Katrin Giese
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Sigurros Davidsdottir
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (S.D.)
| | - Panagiotis Fotiadis
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Raffaella Valenti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Italy (R.V.)
| | - Grace Riley
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Kristin Schwab
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Edip M Gurol
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Alessandro Biffi
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Steven M Greenberg
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Anand Viswanathan
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
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19
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Schreiber S, Wilisch-Neumann A, Schreiber F, Assmann A, Scheumann V, Perosa V, Jandke S, Mawrin C, Carare RO, Werring DJ. Invited Review: The spectrum of age-related small vessel diseases: potential overlap and interactions of amyloid and nonamyloid vasculopathies. Neuropathol Appl Neurobiol 2019; 46:219-239. [PMID: 31386773 DOI: 10.1111/nan.12576] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022]
Abstract
Deep perforator arteriopathy (DPA) and cerebral amyloid angiopathy (CAA) are the commonest known cerebral small vessel diseases (CSVD), which cause ischaemic stroke, intracebral haemorrhage (ICH) and vascular cognitive impairment (VCI). While thus far mainly considered as separate entities, we here propose that DPA and CAA share similarities, overlap and interact, so that 'pure' DPA or CAA are extremes along a continuum of age-related small vessel pathologies. We suggest blood-brain barrier (BBB) breakdown, endothelial damage and impaired perivascular β-amyloid (Aβ) drainage are hallmark common mechanisms connecting DPA and CAA. We also suggest a need for new biomarkers (e.g. high-resolution imaging) to deepen understanding of the complex relationships between DPA and CAA.
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Affiliation(s)
- S Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany.,Center for behavioral brain sciences (CBBS), Magdeburg, Germany
| | - A Wilisch-Neumann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - F Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - A Assmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - V Scheumann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - V Perosa
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - S Jandke
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - C Mawrin
- Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - R O Carare
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - D J Werring
- Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
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20
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Hatada Y, Hashimoto M, Shiraishi S, Ishikawa T, Fukuhara R, Yuki S, Tanaka H, Miyagawa Y, Kitajima M, Uetani H, Tsunoda N, Koyama A, Ikeda M. Cerebral Microbleeds Are Associated with Cerebral Hypoperfusion in Patients with Alzheimer’s Disease. J Alzheimers Dis 2019; 71:273-280. [DOI: 10.3233/jad-190272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Yutaka Hatada
- Department of Psychiatry, Heisei Hospital, Yatsushiro, Kumamoto, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomohisa Ishikawa
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryuji Fukuhara
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Seiji Yuki
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Hibiki Tanaka
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Yusuke Miyagawa
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Mika Kitajima
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Uetani
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoko Tsunoda
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Asuka Koyama
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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21
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Standring OJ, Friedberg J, Tripodis Y, Chua AS, Cherry JD, Alvarez VE, Huber BR, Xia W, Mez J, Alosco ML, Nicks R, Mahar I, Pothast MJ, Gardner HM, Meng G, Palmisano JN, Martin BM, Dwyer B, Kowall NW, Cantu RC, Goldstein LE, Katz DI, Stern RA, McKee AC, Stein TD. Contact sport participation and chronic traumatic encephalopathy are associated with altered severity and distribution of cerebral amyloid angiopathy. Acta Neuropathol 2019; 138:401-413. [PMID: 31183671 DOI: 10.1007/s00401-019-02031-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 12/14/2022]
Abstract
Cerebral amyloid angiopathy (CAA) consists of beta-amyloid deposition in the walls of the cerebrovasculature and is commonly associated with Alzheimer's disease (AD). However, the association of CAA with repetitive head impacts (RHI) and with chronic traumatic encephalopathy (CTE) is unknown. We evaluated the relationship between RHI from contact sport participation, CTE, and CAA within a group of deceased contact sport athletes (n = 357), a community-based cohort (n = 209), and an AD cohort from Boston University AD Center (n = 241). Unsupervised hierarchal cluster analysis demonstrated a unique cluster (n = 11) with increased CAA in the leptomeningeal vessels compared to the intracortical vessels (p < 0.001) comprised of participants with significantly greater frequencies of CTE (7/11) and history of RHI. Overall, participants with CTE (n = 251) had more prevalent (p < 0.001) and severe (p = 0.010) CAA within the frontal leptomeningeal vessels compared to intracortical vessels. Compared to those with AD, participants with CTE had more severe CAA in frontal than parietal lobes (p < 0.001) and more severe CAA in leptomeningeal than intracortical vessels (p = 0.002). The overall frequency of CAA in participants with CTE was low, and there was no significant association between contact sport participation and the presence of CAA. However, in those with CAA, a history of contact sports was associated with increased CAA severity in the frontal leptomeningeal vessels (OR = 4.01, 95% CI 2.52-6.38, p < 0.001) adjusting for AD, APOE ε4 status, and age. Participants with CAA had increased levels of sulcal tau pathology and decreased levels of the synaptic marker PSD-95 (p's < 0.05), and CAA was a predictor of dementia (OR = 1.75, 95% CI 1.02-2.99, p = 0.043) adjusting for age, sex, and comorbid pathology. Overall, contact sport participation and CTE were associated with more severe frontal and leptomeningeal CAA, and CAA was independently associated with worse pathological and clinical outcomes.
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Affiliation(s)
- Oliver J Standring
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Jacob Friedberg
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Yorghos Tripodis
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, 20118, USA
| | - Alicia S Chua
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, 20118, USA
| | - Jonathan D Cherry
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Victor E Alvarez
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Bertrand R Huber
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Weiming Xia
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Jesse Mez
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Michael L Alosco
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Raymond Nicks
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Ian Mahar
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Morgan J Pothast
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Hannah M Gardner
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Gaoyuan Meng
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
| | - Joseph N Palmisano
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA
| | - Brett M Martin
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA
| | - Brigid Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, 02118, USA
| | - Neil W Kowall
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
| | - Robert C Cantu
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, 20119, USA
- Concussion Legacy Foundation, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA, 02118, USA
- Department of Neurosurgery, Emerson Hospital, Concord, MA, 01742, USA
| | - Lee E Goldstein
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Departments of Psychiatry, Ophthalmology, Boston University School of Medicine, Boston, USA
- Departments of Biomedical, Electrical and Computer Engineering, Boston University College of Engineering, Boston, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, 02118, USA
| | - Robert A Stern
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, 20119, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Ann C McKee
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, 20118, USA
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Thor D Stein
- Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston University, Boston, MA, 02118, USA.
- VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA.
- Department of Veterans Affairs Medical Centers, Bedford, MA, 01730, USA.
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, 02118, USA.
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22
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van den Brink H, Zwiers A, Switzer AR, Charlton A, McCreary CR, Goodyear BG, Frayne R, Biessels GJ, Smith EE. Cortical Microinfarcts on 3T Magnetic Resonance Imaging in Cerebral Amyloid Angiopathy. Stroke 2019; 49:1899-1905. [PMID: 29986931 DOI: 10.1161/strokeaha.118.020810] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Cerebral microinfarcts are small ischemic lesions that are found in cerebral amyloid angiopathy (CAA) patients at autopsy. The current study aimed to detect cortical microinfarcts (CMI) on in vivo 3 Tesla (3T) magnetic resonance imaging (MRI) in CAA patients, to study the progression of CMI over a 1-year period, and to correlate CMI with markers of CAA-related vascular brain injury and cognitive functioning. Methods- Thirty-five CAA patients (mean age, 74.2±7.6 years), 13 Alzheimer disease (AD) patients (67.0±5.8 years), and 26 healthy controls (67.2±9.5 years) participated in the study. All participants underwent a standardized clinical and neuropsychological assessment as well as 3T MRI. CMI were rated according to standardized criteria. Results- CMI were present in significantly more CAA patients (57.1%; median number: 1, range 1-9) than in Alzheimer disease (7.7%) or in healthy controls (11.5%; P<0.001). Incident CMI were observed after a 1-year follow-up. CMI did not correlate with any other MRI marker of CAA nor with cognitive function. Conclusions- In vivo CMI are a frequent finding on 3T MRI in CAA patients, and incident CMI are observable after 1-year follow-up. CMI can be regarded as a new MRI marker of CAA, potentially distinct from other well-established markers. Future larger cohort studies with longitudinal follow-up are needed to elucidate the relationship between CMI and possible causes and clinical outcomes in CAA.
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Affiliation(s)
- Hilde van den Brink
- From the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands (H.v.d.B., G.J.B.)
| | - Angela Zwiers
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.)
| | - Aaron R Switzer
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.)
| | - Anna Charlton
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.)
| | - Cheryl R McCreary
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.).,Department of Radiology (B.G.G., C.R.M., E.E.S., R.F.), University of Calgary, AB, Canada
| | - Bradley G Goodyear
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.).,Department of Radiology (B.G.G., C.R.M., E.E.S., R.F.), University of Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, University of Calgary, AB, Canada (B.G.G., R.F.)
| | - Richard Frayne
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.).,Department of Radiology (B.G.G., C.R.M., E.E.S., R.F.), University of Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, University of Calgary, AB, Canada (B.G.G., R.F.)
| | - Geert Jan Biessels
- From the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands (H.v.d.B., G.J.B.)
| | - Eric E Smith
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.).,Department of Radiology (B.G.G., C.R.M., E.E.S., R.F.), University of Calgary, AB, Canada
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23
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Ii Y, Maeda M, Ishikawa H, Ito A, Matsuo K, Umino M, Shindo A, Kida H, Satoh M, Niwa A, Taniguchi A, Tomimoto H. Cortical microinfarcts in patients with multiple lobar microbleeds on 3 T MRI. J Neurol 2019; 266:1887-1896. [DOI: 10.1007/s00415-019-09350-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/13/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
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24
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Jonkman LE, Kenkhuis B, Geurts JJG, van de Berg WDJ. Post-Mortem MRI and Histopathology in Neurologic Disease: A Translational Approach. Neurosci Bull 2019; 35:229-243. [PMID: 30790214 DOI: 10.1007/s12264-019-00342-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/29/2018] [Indexed: 01/28/2023] Open
Abstract
In this review, combined post-mortem brain magnetic resonance imaging (MRI) and histology studies are highlighted, illustrating the relevance of translational approaches to define novel MRI signatures of neuropathological lesions in neuroinflammatory and neurodegenerative disorders. Initial studies combining post-mortem MRI and histology have validated various MRI sequences, assessing their sensitivity and specificity as diagnostic biomarkers in neurologic disease. More recent studies have focused on defining new radiological (bio)markers and implementing them in the clinical (research) setting. By combining neurological and neuroanatomical expertise with radiological development and pathological validation, a cycle emerges that allows for the discovery of novel MRI biomarkers to be implemented in vivo. Examples of this cycle are presented for multiple sclerosis, Alzheimer's disease, Parkinson's disease, and traumatic brain injury. Some applications have been shown to be successful, while others require further validation. In conclusion, there is much to explore with post-mortem MRI and histology studies, which can eventually be of high relevance for clinical practice.
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Affiliation(s)
- Laura E Jonkman
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Boyd Kenkhuis
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Wilma D J van de Berg
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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25
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Infratentorial Cerebral Microbleeds in Patients with Cerebral Amyloid Angiopathy. J Stroke Cerebrovasc Dis 2018; 27:2534-2537. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/15/2018] [Indexed: 11/18/2022] Open
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26
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Umino M, Maeda M, Ii Y, Tomimoto H, Sakuma H. 3D double inversion recovery MR imaging: Clinical applications and usefulness in a wide spectrum of central nervous system diseases. J Neuroradiol 2018; 46:107-116. [PMID: 30016704 DOI: 10.1016/j.neurad.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/03/2018] [Accepted: 06/23/2018] [Indexed: 12/31/2022]
Abstract
Double inversion recovery (DIR) imaging provides two inversion pulses that attenuate signals from cerebrospinal fluid and normal white matter. This review was undertaken to describe the principle of the DIR sequence, the clinical applications of 3D DIR in various central nervous system diseases and the clinical benefits of the 3D DIR compared with those of other MR sequences. 3D DIR imaging provides better lesion conspicuity and topography than other MR techniques. It is particularly useful for diagnosing the following disease entities: cortical and subcortical abnormalities such as multiple sclerosis, cortical microinfarcts and cortical development anomalies; sulcal abnormalities such as meningitis and subacute/chronic subarachnoid hemorrhage; and optic neuritis caused by multiple sclerosis or neuromyelitis optica.
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Affiliation(s)
- Maki Umino
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Mie, Japan.
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University School of Medicine, Tsu, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Mie, Japan
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27
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Abstract
PURPOSE OF REVIEW Cerebral amyloid angiopathy (CAA) is diagnosed primarily as a cause of lobar intracerebral hemorrhages (ICH) in elderly patients. With improving MRI techniques, however, the role of CAA in causing other symptoms has become clear. Recognizing the full clinical spectrum of CAA is important for diagnosis and treatment. In this review we summarize recent insights in clinical CAA features, MRI biomarkers, and management. RECENT FINDINGS The rate of ICH recurrence in CAA is among the highest of all stroke subtypes. Cortical superficial siderosis (cSS) and cortical subarachnoid hemorrhage (cSAH) are important imaging predictors for recurrent ICH. CAA also causes cognitive problems in multiple domains. In patients with nondemented CAA, the risk of developing dementia is high especially after ICH. CAA pathology probably starts years before the first clinical manifestations. The first signs in hereditary CAA are white matter lesions, cortical microinfarcts, and impaired occipital cerebral vasoreactivity. Visible centrum semiovale perivascular spaces, lobar located lacunes, and cortical atrophy are new nonhemorrhagic MRI markers. SUMMARY CAA should be in the differential diagnosis of elderly patients with lobar ICH but also in those with cognitive decline and episodic transient neurological symptoms. Physicians should be aware of the cognitive effects of CAA. In patients with a previous ICH, cSS, or cSAH, anticoagulation should be considered risky. The increasing number of MRI markers may help to discriminate CAA from other small vessel diseases and dementia subtypes.
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28
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Kapasi A, Leurgans SE, James BD, Boyle PA, Arvanitakis Z, Nag S, Bennett DA, Buchman AS, Schneider JA. Watershed microinfarct pathology and cognition in older persons. Neurobiol Aging 2018; 70:10-17. [PMID: 29935416 DOI: 10.1016/j.neurobiolaging.2018.05.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/27/2022]
Abstract
Brain microinfarcts are common in aging and are associated with cognitive impairment. Anterior and posterior watershed border zones lie at the territories of the anterior, middle, and posterior cerebral arteries, and are more vulnerable to hypoperfusion than brain regions outside the watershed areas. However, little is known about microinfarcts in these regions and how they relate to cognition in aging. Participants from the Rush Memory and Aging Project, a community-based clinical-pathologic study of aging, underwent detailed annual cognitive evaluations. We examined 356 consecutive autopsy cases (mean age-at-death, 91 years [SD = 6.16]; 28% men) for microinfarcts from 3 watershed brain regions (2 anterior and 1 posterior) and 8 brain regions outside the watershed regions. Linear regression models were used to examine the association of cortical watershed microinfarcts with cognition, including global cognition and 5 cognitive domains. Microinfarcts in any region were present in 133 (37%) participants, of which 50 had microinfarcts in watershed regions. Persons with multiple microinfarcts in cortical watershed regions had lower global cognition (estimate = -0.56, standard error (SE) = 0.26, p = 0.03) and lower cognitive function in the specific domains of working memory (estimate = -0.58, SE = 0.27, p = 0.03) and visuospatial abilities (estimate = -0.57, SE = 0.27, p = 0.03), even after controlling for microinfarcts in other brain regions, demographics, and age-related pathologies. Neither the presence nor multiplicity of microinfarcts in brain regions outside the cortical watershed regions were related to global cognition or any of the 5 cognitive domains. These findings suggest that multiple microinfarcts in watershed regions contribute to age-related cognitive impairment.
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Affiliation(s)
- Alifiya Kapasi
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, USA.
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Bryan D James
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Zoe Arvanitakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sukriti Nag
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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29
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Hecht M, Krämer LM, von Arnim CAF, Otto M, Thal DR. Capillary cerebral amyloid angiopathy in Alzheimer's disease: association with allocortical/hippocampal microinfarcts and cognitive decline. Acta Neuropathol 2018; 135:681-694. [PMID: 29574591 DOI: 10.1007/s00401-018-1834-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 01/03/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is caused by the deposition of the amyloid β-protein (Aβ) in the wall of cerebral and leptomeningeal blood vessels and is related to Alzheimer's disease (AD). Capillary Aβ deposition is observed in a subset of CAA cases and represents a distinct type of CAA named capillary CAA or CAA type 1. This type of CAA is strongly associated with the presence of the apolipoprotein E ε4 allele. CAA type 1-associated AD cases often exhibit a more severe Aβ plaque pathology but less widespread neurofibrillary tangle (NFT) pathology. The objective of this study was to analyze whether capillary CAA and its effects on cerebral blood flow have an impact on dementia. To address this objective, we performed neuropathological evaluation of 284 autopsy cases of demented and non-demented individuals. We assessed the presence of CAA and its subtypes as well as for that of hemorrhages and infarcts. Capillary CAA and CAA severity were associated with allocortical microinfarcts, comprising the CA1 region of the hippocampus. Allocortical microinfarcts, capillary CAA and CAA severity were, thereby, associated with cognitive decline. In conclusion, allocortical microinfarcts, CAA severity, and the capillary type of CAA were associated with one another and with the development of cognitive decline. Thus, AD cases with CAA type 1 (capillary CAA) appear to develop dementia symptoms not only due to AD-related Aβ plaque and NFT pathology but also due to hippocampal microinfarcts that are associated with CAA type 1 and CAA severity, and that damage a brain region important for memory function.
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Affiliation(s)
- Moritz Hecht
- Laboratory of Neuropathology, Institute of Pathology, University of Ulm, Ulm, Germany
| | - Lara Maria Krämer
- Laboratory of Neuropathology, Institute of Pathology, University of Ulm, Ulm, Germany
| | - Christine A F von Arnim
- Department of Neurology, University of Ulm, Ulm, Germany
- Clinic for Neurogeriatrics and neurological Rehabilitation, University- und Rehabilitation Hospital Ulm (RKU), Ulm, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Dietmar Rudolf Thal
- Laboratory of Neuropathology, Institute of Pathology, University of Ulm, Ulm, Germany.
- Departement Neurowetenschappen, Katholieke Universiteit Leuven, Herestraat 49, Leuven, Belgium.
- Departement Pathologische Ontleedkunde, UZ Leuven, Leuven, Belgium.
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30
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Xu XH, Gao T, Zhang WJ, Tong LS, Gao F. Remote Diffusion-Weighted Imaging Lesions in Intracerebral Hemorrhage: Characteristics, Mechanisms, Outcomes, and Therapeutic Implications. Front Neurol 2017; 8:678. [PMID: 29326644 PMCID: PMC5736543 DOI: 10.3389/fneur.2017.00678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/28/2017] [Indexed: 01/05/2023] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH) is one of the most fatal form of stroke, with high mortality and disability rate. Small diffusion-weighed imaging lesions are not rare to see in regions remote from the hematoma after ICH and have been generally considered as related with poor outcome. In this review, we described the characteristics of remote ischemic lesions, discussed the possible mechanisms and clinical outcomes of these lesions, and evaluated the potential therapeutic implications.
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Affiliation(s)
- Xu-Hua Xu
- School of Medicine, Zhejiang University, Hangzhou, China.,Department of Neurology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Ting Gao
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen-Ji Zhang
- Department of Radiology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Lu-Sha Tong
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feng Gao
- School of Medicine, Zhejiang University, Hangzhou, China.,Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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31
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van Veluw SJ, Shih AY, Smith EE, Chen C, Schneider JA, Wardlaw JM, Greenberg SM, Biessels GJ. Detection, risk factors, and functional consequences of cerebral microinfarcts. Lancet Neurol 2017; 16:730-740. [PMID: 28716371 PMCID: PMC5861500 DOI: 10.1016/s1474-4422(17)30196-5] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/17/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023]
Abstract
Cerebral microinfarcts are small lesions that are presumed to be ischaemic. Despite the small size of these lesions, affected individuals can have hundreds to thousands of cerebral microinfarcts, which cause measurable disruption to structural brain connections, and are associated with dementia that is independent of Alzheimer's disease pathology or larger infarcts (ie, lacunar infarcts, and large cortical and non-lacunar subcortical infarcts). Substantial progress has been made with regard to understanding risk factors and functional consequences of cerebral microinfarcts, partly driven by new in-vivo detection methods and the development of animal models that closely mimic multiple aspects of cerebral microinfarcts in human beings. Evidence from these advances suggests that cerebral microinfarcts can be manifestations of both small vessel and large vessel disease, that cerebral microinfarcts are independently associated with cognitive impairment, and that these lesions are likely to cause damage to brain structure and function that extends beyond their actual lesion boundaries. Criteria for the identification of cerebral microinfarcts with in-vivo MRI are provided to support further studies of the association between these lesions and cerebrovascular disease and dementia.
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Affiliation(s)
- Susanne J van Veluw
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andy Y Shih
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Chen
- Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
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32
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Impact of multiple pathologies on the threshold for clinically overt dementia. Acta Neuropathol 2017; 134:171-186. [PMID: 28488154 DOI: 10.1007/s00401-017-1717-7] [Citation(s) in RCA: 375] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 12/14/2022]
Abstract
Longitudinal clinical-pathological studies have increasingly recognized the importance of mixed pathologies (the coexistence of one or more neurodegenerative and cerebrovascular disease pathologies) as important factors in the development of Alzheimer's disease (AD) and other forms of dementia. Older persons with AD pathology, often have concomitant cerebrovascular disease pathologies (macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy) as well as other concomitant neurodegenerative disease pathologies (Lewy bodies, TDP-43, hippocampal sclerosis). These additional pathologies lower the threshold for clinical diagnosis of AD. Many of these findings from pathologic studies, especially for CVD, have been confirmed using sophisticated neuroimaging technologies. In vivo biomarker studies are necessary to provide an understanding of specific pathologic contributions and time course relationships along the spectrum of accumulating pathologies. In this review, we provide a clinical-pathological perspective on the role of multiple brain pathologies in dementia followed by a review of the available clinical and biomarker data on some of the mixed pathologies.
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Love S, Miners JS. Small vessel disease, neurovascular regulation and cognitive impairment: post-mortem studies reveal a complex relationship, still poorly understood. Clin Sci (Lond) 2017; 131:1579-1589. [PMID: 28667060 DOI: 10.1042/cs20170148] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/08/2023]
Abstract
The contribution of vascular disease to cognitive impairment is under-recognized and the pathogenesis is poorly understood. This information gap has multiple causes, including a lack of post-mortem validation of clinical diagnoses of vascular cognitive impairment (VCI) or vascular dementia (VaD), the exclusion of cases with concomitant neurodegenerative disease when diagnosing VCI/VaD, and a lack of standardization of neuropathological assessment protocols for vascular disease. Other contributors include a focus on end-stage destructive lesions to the exclusion of more subtle types of diffuse brain injury, on structural abnormalities of arteries and arterioles to the exclusion of non-structural abnormalities and capillary damage, and the use of post-mortem sampling strategies that are biased towards the identification of neurodegenerative pathologies. Recent studies have demonstrated the value of detailed neuropathology in characterizing vascular contributions to cognitive impairment (e.g. in diabetes), and highlight the importance of diffuse white matter changes, capillary damage and vasoregulatory abnormalities in VCI/VaD. The use of standardized, evidence-based post-mortem assessment protocols and the inclusion of biochemical as well as morphological methods in neuropathological studies should improve the accuracy of determination of the contribution of vascular disease to cognitive impairment and clarify the relative contribution of different pathogenic processes to the tissue damage.
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Affiliation(s)
- Seth Love
- Dementia Research Group, School of Clinical Sciences, University of Bristol, Learning and Research Level 1, Southmead Hospital, Bristol BS10 5NB, U.K.
| | - J Scott Miners
- Dementia Research Group, School of Clinical Sciences, University of Bristol, Learning and Research Level 1, Southmead Hospital, Bristol BS10 5NB, U.K
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