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Li H, Jacob MA, Cai M, Kessels RPC, Norris DG, Duering M, De Leeuw FE, Tuladhar AM. Perivascular Spaces, Diffusivity Along Perivascular Spaces, and Free Water in Cerebral Small Vessel Disease. Neurology 2024; 102:e209306. [PMID: 38626373 DOI: 10.1212/wnl.0000000000209306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies have linked the MRI measures of perivascular spaces (PVSs), diffusivity along the perivascular spaces (DTI-ALPS), and free water (FW) to cerebral small vessel disease (SVD) and SVD-related cognitive impairments. However, studies on the longitudinal associations between the three MRI measures, SVD progression, and cognitive decline are lacking. This study aimed to explore how PVS, DTI-ALPS, and FW contribute to SVD progression and cognitive decline. METHODS This is a cohort study that included participants with SVD who underwent neuroimaging and cognitive assessment, specifically measuring Mini-Mental State Examination (MMSE), cognitive index, and processing speed, at 2 time points. Three MRI measures were quantified: PVS in basal ganglia (BG-PVS) volumes, FW fraction, and DTI-ALPS. We performed a latent change score model to test inter-relations between the 3 MRI measures and linear regression mixed models to test their longitudinal associations with the changes of other SVD MRI markers and cognitive performances. RESULTS In baseline assessment, we included 289 participants with SVD, characterized by a median age of 67.0 years and 42.9% women. Of which, 220 participants underwent the follow-up assessment, with a median follow-up time of 3.4 years. Baseline DTI-ALPS was associated with changes in BG-PVS volumes (β = -0.09, p = 0.030), but not vice versa (β = -0.08, p = 0.110). Baseline BG-PVS volumes were associated with changes in white matter hyperintensity (WMH) volumes (β = 0.33, p-corrected < 0.001) and lacune numbers (β = 0.28, p-corrected < 0.001); FW fraction was associated with changes in WMH volumes (β = 0.30, p-corrected < 0.001), lacune numbers (β = 0.28, p-corrected < 0.001), and brain volumes (β = -0.45, p-corrected < 0.001); DTI-ALPS was associated with changes in WMH volumes (β = -0.20, p-corrected = 0.002) and brain volumes (β = 0.23, p-corrected < 0.001). Furthermore, baseline FW fraction was associated with decline in MMSE score (β = -0.17, p-corrected = 0.006); baseline FW fraction and DTI-ALPS were associated with changes in cognitive index (FW fraction: β = -0.25, p-corrected < 0.001; DTI-ALPS: β = 0.20, p-corrected = 0.001) and processing speed over time (FW fraction: β = -0.29, p-corrected < 0.001; DTI-ALPS: β = 0.21, p-corrected < 0.001). DISCUSSION Our results showed that increased BG-PVS volumes, increased FW fraction, and decreased DTI-ALPS are related to progression of MRI markers of SVD, along with SVD-related cognitive decline over time. These findings may suggest that the glymphatic dysfunction is related to SVD progression, but further studies are needed.
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Affiliation(s)
- Hao Li
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Mina A Jacob
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Mengfei Cai
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Roy P C Kessels
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - David G Norris
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Marco Duering
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Frank-Erik De Leeuw
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Anil Man Tuladhar
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
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Huang K, Zhao T, Sun W, Feng L, Wang Q, Feng J. Memory deficit in patients with cerebral small vessel disease: evidence from eye tracking technology. Cereb Cortex 2024; 34:bhae138. [PMID: 38602738 DOI: 10.1093/cercor/bhae138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/12/2024] Open
Abstract
Cerebral small vessel disease is the one of the most prevalent causes of vascular cognitive impairment. We aimed to find objective and process-based indicators related to memory function to assist in the detection of memory impairment in patients with cerebral small vessel disease. Thirty-nine cerebral small vessel disease patients and 22 healthy controls were invited to complete neurological examinations, neuropsychological assessments, and eye tracking tasks. Eye tracking indicators were recorded and analyzed in combination with imaging features. The cerebral small vessel disease patients scored lower on traditional memory task and performed worse on eye tracking memory task performance compared to the healthy controls. The cerebral small vessel disease patients exhibited longer visit duration and more visit count within areas of interest and targets and decreased percentage value of total visit duration on target images to total visit duration on areas of interest during decoding stage among all levels. Our results demonstrated the cerebral small vessel disease patients performed worse in memory scale and eye tracking memory task, potentially due to their heightened attentional allocation to nontarget images during the retrieval stage. The eye tracking memory task could provide process-based indicators to be a beneficial complement to memory assessment and new insights into mechanism of memory impairment in cerebral small vessel disease patients.
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Affiliation(s)
- Kailing Huang
- Department of Neurology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, P.R. China
| | - Tingting Zhao
- Department of Neurology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, P.R. China
| | - Weifeng Sun
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, No. 17, Information Avenue, New Industrial Park, High-tech Zone, Xi'an 710119, Shaanxi Province, P.R. China
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, No. 17, Information Avenue, New Industrial Park, High-tech Zone, Xi'an 710119, Shaanxi Province, P.R. China
- University of Chinese Academy of Sciences, No. 1, Yanqihu East Road, Huairou District, Beijing 101408, P.R. China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, P.R. China
| | - Quan Wang
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, No. 17, Information Avenue, New Industrial Park, High-tech Zone, Xi'an 710119, Shaanxi Province, P.R. China
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, No. 17, Information Avenue, New Industrial Park, High-tech Zone, Xi'an 710119, Shaanxi Province, P.R. China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, P.R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, P.R. China
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Barucci E, Salvadori E, Magi S, Squitieri M, Fiore GM, Ramacciotti L, Formelli B, Pescini F, Poggesi A. Cognitive profile in cerebral small vessel disease: comparison between cerebral amyloid angiopathy and hypertension-related microangiopathy. Sci Rep 2024; 14:5922. [PMID: 38467658 PMCID: PMC10928167 DOI: 10.1038/s41598-024-55719-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
Cerebral amyloid angiopathy (CAA) is recognized as a cause of cognitive impairment, but its cognitive profile needs to be characterized, also respect to hypertension-related microangiopathy (HA). We aimed at comparing difference or similarity of CAA and HA patients' cognitive profiles, and their associated factors. Participants underwent an extensive clinical, neuropsychological, and neuroimaging protocol. HA patients (n = 39) were more frequently males, with history of vascular risk factors than CAA (n = 32). Compared to HA, CAA patients presented worse performance at MoCA (p = 0.001) and semantic fluency (p = 0.043), and a higher prevalence of amnestic MCI (46% vs. 68%). In univariate analyses, multi-domain MCI was associated with worse performance at MoCA, Rey Auditory Verbal Learning Test (RAVLT), and semantic fluency in CAA patients, and with worse performance at Symbol Digit Modalities Test (SDMT) and phonemic fluency in HA ones. In multivariate models, multi-domain deficit remained as the only factor associated with RAVLT (β = - 0.574) in CAA, while with SDMT (β = - 0.364) and phonemic fluency (β = - 0.351) in HA. Our results highlight different patterns of cognitive deficits in CAA or HA patients. While HA patients' cognitive profile was confirmed as mainly attentional/executive, a complex cognitive profile, characterized also by deficit in semantic memory, seems the hallmark of CAA patients.
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Affiliation(s)
- Eleonora Barucci
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Emilia Salvadori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Simona Magi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Martina Squitieri
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Giulio Maria Fiore
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Lorenzo Ramacciotti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Benedetta Formelli
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesca Pescini
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
- Stroke Unit, Careggi University Hospital, Florence, Italy.
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Marcolini S, Mondragón JD, Bron EE, Biessels GJ, Claassen JA, Papma JM, Middelkoop H, Dierckx RA, Borra RJ, Ramakers IH, van der Flier WM, Maurits NM, De Deyn PP. Small vessel disease burden and functional brain connectivity in mild cognitive impairment. Cereb Circ Cogn Behav 2023; 6:100192. [PMID: 38174052 PMCID: PMC10758699 DOI: 10.1016/j.cccb.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Background The role of small vessel disease in the development of dementia is not yet completely understood. Functional brain connectivity has been shown to differ between individuals with and without cerebral small vessel disease. However, a comprehensive measure of small vessel disease quantifying the overall damage on the brain is not consistently used and studies using such measure in mild cognitive impairment individuals are missing. Method Functional brain connectivity differences were analyzed between mild cognitive impairment individuals with absent or low (n = 34) and high (n = 34) small vessel disease burden using data from the Parelsnoer Institute, a Dutch multicenter study. Small vessel disease was characterized using an ordinal scale considering: lacunes, microbleeds, perivascular spaces in the basal ganglia, and white matter hyperintensities. Resting state functional MRI data using 3 Tesla scanners was analyzed with group-independent component analysis using the CONN toolbox. Results Functional connectivity between areas of the cerebellum and between the cerebellum and the thalamus and caudate nucleus was higher in the absent or low small vessel disease group compared to the high small vessel disease group. Conclusion These findings might suggest that functional connectivity of mild cognitive impairment individuals with low or absent small vessel disease burden is more intact than in mild cognitive impairment individuals with high small vessel disease. These brain areas are mainly responsible for motor, attentional and executive functions, domains which in previous studies were found to be mostly associated with small vessel disease markers. Our results support findings on the involvement of the cerebellum in cognitive functioning.
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Affiliation(s)
- Sofia Marcolini
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
| | - Jaime D. Mondragón
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Departamento de Neurobiología Conductual y Cognitiva, Laboratorio de Psicofisiología, Querétaro 76230, Mexico
- San Diego State University, Department of Psychology, Life-Span Human Senses Lab, San Diego, California 92182, USA
| | - Esther E. Bron
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam 3015 GD, the Netherlands
| | - Geert J. Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht 3584 CX, the Netherlands
| | - Jurgen A.H.R. Claassen
- Department of Geriatrics, Radboud University Medical Center and Donders Institute, Nijmegen 6525 GD, the Netherlands
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Janne M. Papma
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam 3015 GD, the Netherlands
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam 3015 GD, the Netherlands
| | - Huub Middelkoop
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden 2316 XC, the Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden 2333 ZA, the Netherlands
| | - Rudi A.J.O. Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, the Netherlands
| | - Ronald J.H. Borra
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, the Netherlands
| | - Inez H.G.B. Ramakers
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht 6229 ER, the Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam 1081 HZ, the Netherlands
- Department of Epidemiology & Data Sciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam 1117, the Netherlands
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
| | - Peter P. De Deyn
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, the Netherlands
- Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerp 2610, Belgium
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Li H, Jacob MA, Cai M, Duering M, Chamberland M, Norris DG, Kessels RPC, de Leeuw FE, Marques JP, Tuladhar AM. Regional cortical thinning, demyelination and iron loss in cerebral small vessel disease. Brain 2023; 146:4659-4673. [PMID: 37366338 PMCID: PMC10629800 DOI: 10.1093/brain/awad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023] Open
Abstract
The link between white matter hyperintensities (WMH) and cortical thinning is thought to be an important pathway by which WMH contributes to cognitive deficits in cerebral small vessel disease (SVD). However, the mechanism behind this association and the underlying tissue composition abnormalities are unclear. The objective of this study is to determine the association between WMH and cortical thickness, and the in vivo tissue composition abnormalities in the WMH-connected cortical regions. In this cross-sectional study, we included 213 participants with SVD who underwent standardized protocol including multimodal neuroimaging scans and cognitive assessment (i.e. processing speed, executive function and memory). We identified the cortex connected to WMH using probabilistic tractography starting from the WMH and defined the WMH-connected regions at three connectivity levels (low, medium and high connectivity level). We calculated the cortical thickness, myelin and iron of the cortex based on T1-weighted, quantitative R1, R2* and susceptibility maps. We used diffusion-weighted imaging to estimate the mean diffusivity of the connecting white matter tracts. We found that cortical thickness, R1, R2* and susceptibility values in the WMH-connected regions were significantly lower than in the WMH-unconnected regions (all Pcorrected < 0.001). Linear regression analyses showed that higher mean diffusivity of the connecting white matter tracts were related to lower thickness (β = -0.30, Pcorrected < 0.001), lower R1 (β = -0.26, Pcorrected = 0.001), lower R2* (β = -0.32, Pcorrected < 0.001) and lower susceptibility values (β = -0.39, Pcorrected < 0.001) of WMH-connected cortical regions at high connectivity level. In addition, lower scores on processing speed were significantly related to lower cortical thickness (β = 0.20, Pcorrected = 0.030), lower R1 values (β = 0.20, Pcorrected = 0.006), lower R2* values (β = 0.29, Pcorrected = 0.006) and lower susceptibility values (β = 0.19, Pcorrected = 0.024) of the WMH-connected regions at high connectivity level, independent of WMH volumes and the cortical measures of WMH-unconnected regions. Together, our study demonstrated that the microstructural integrity of white matter tracts passing through WMH is related to the regional cortical abnormalities as measured by thickness, R1, R2* and susceptibility values in the connected cortical regions. These findings are indicative of cortical thinning, demyelination and iron loss in the cortex, which is most likely through the disruption of the connecting white matter tracts and may contribute to processing speed impairment in SVD, a key clinical feature of SVD. These findings may have implications for finding intervention targets for the treatment of cognitive impairment in SVD by preventing secondary degeneration.
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Affiliation(s)
- Hao Li
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Mina A Jacob
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Mengfei Cai
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 510080 Guangzhou, China
| | - Marco Duering
- Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering, University of Basel, 4051 Basel, Switzerland
- LMU Munich, University Hospital, Institute for Stroke and Dementia Research (ISD), 81377 Munich, Germany
| | - Maxime Chamberland
- Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, 6525 EN Nijmegen, The Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, 6525 EN Nijmegen, The Netherlands
| | - Roy P C Kessels
- Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Center, 6525 GC, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 EN Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, 5803 AC Venray, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - José P Marques
- Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, 6525 EN Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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Wang X, Shi Y, Chen Y, Gao Y, Wang T, Li Z, Wang Y. Blood-Brain Barrier Breakdown is a Sensitive Biomarker of Cognitive and Language Impairment in Patients with White Matter Hyperintensities. Neurol Ther 2023; 12:1745-1758. [PMID: 37490234 PMCID: PMC10444912 DOI: 10.1007/s40120-023-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Similar white matter hyperintensities (WMH) burden may have varied cognitive outcomes in patients with cerebral small vessel disease (CSVD). This study aimed to evaluate whether blood-brain barrier (BBB) permeability is associated with cognitive impairment (CI) heterogeneity in patients with WMH. METHODS We recruited 51 participants with WMH. We evaluated WMH burden using the Fazekas scale and WMH volume on structural magnetic resonance imaging (MRI), and assessed BBB permeability using dynamic contrast-enhanced (DCE)-MRI. We used permeability-surface area product (PS) from the Patlak model to represent BBB permeability. All patients underwent Mini-Mental State Examination (MMSE), Boston Naming Test (BNT) and animal verbal fluency test (VFT) for cognitive assessment. We divided patients into CI and non-CI groups based on their MMSE scores (< 27 or ≥ 27) and used multiple linear regression models to investigate the associations between MRI parameters and cognitive function. RESULTS Patients in the two groups did not differ in Fazekas scores and WMH volume. However, patients in the CI group showed significantly higher PS in the WMH regions than those in non-CI group (1.89 × 10-3 versus 1.00 × 10-3, p = 0.032 in periventricular WMH [PVWMH]; 1.27 × 10-3 versus 0.74 × 10-3, p = 0.043 in deep WMH [DWMH]), indicating the breakdown of BBB in the CI group. In all patients with WMH, increased BBB permeability in PVWMH and DWMH was significantly associated with lower cognitive and language function after adjustment for age, education level (EL) and intracranial volume (ICV). In the CI group, this correlation remained significant. WMH volume was not associated with cognitive performance in either all patients or those with CI. CONCLUSION BBB impairment might be a more sensitive indicator for cognitive and language dysfunction than WMH volume in patients with WMH and possibly explains the heterogeneity of cognitive performance in patients with similar WMH burden.
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Affiliation(s)
- Xing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Yulu Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Yiyi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Ying Gao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Tingting Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Zhengyang Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Chinese Institute for Brain Research, Beijing, 100070, China
- National Centre for Neurological Diseases, Beijing, 100070, China
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- Chinese Institute for Brain Research, Beijing, 100070, China.
- National Centre for Neurological Diseases, Beijing, 100070, China.
- Advanced Innovation Centre for Human Brain Protection, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China.
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China.
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Sempere-Bigorra M, Julián-Rochina I, Pérez-Ros P, Navarro-Flores E, Martínez-Arnau FM, Cauli O. Relationship between Cognitive Impairment and Depressive Symptoms with Somatosensory Functions in Diabetic and Non-Diabetic Older Adults and Its Impact on Quality of Life. Life (Basel) 2023; 13:1790. [PMID: 37763194 PMCID: PMC10532541 DOI: 10.3390/life13091790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/01/2023] [Accepted: 08/19/2023] [Indexed: 09/29/2023] Open
Abstract
Aging is an inevitable process that impacts the peripheral and central nervous systems and is considered one of the strongest risk factors for neurodegenerative diseases. In addition, when it also presents with diabetes mellitus, the risk of neurological damage may be further increased. This current study aimed to explore the relationships between peripheral sensory system decline and cognitive functions, the symptoms of depression, and quality of life (QoL) as metrics of central nervous system impairment in institutionalized older adults. A total of 95 individuals participated in this case-control study, which included diabetics and non-diabetics. The superficial sensory pathway was assessed in terms of thermal sensation, nociception, and non-discriminative touch, and the deep sensory pathway was evaluated by assessing vibration and light touch-pressure sensations. To assess function at the intellectual level, the Mini-Mental State Examination (MMSE) and Trail Making Test (TMT) cognitive functional tests were used, while the symptoms of depression and QoL were explored by employing the Yesavage Geriatric Depression Scale and EuroQol 5D questionnaire (EQ-5D), respectively. In the overall population analyses, altered thermal sensation was significantly associated with cognitive impairment (CI; p < 0.05). In turn, bivariate analyses and a binary logistic regression showed that the symptoms of depression and QoL were significantly related to altered vibratory sensation when assessed using a medical tuning fork (p < 0.05). In the group of diabetic patients, those with CI also had significantly lower thermal sensation (p < 0.05) and non-discriminative touch sensation, although this was only a trend (p = 0.055). Diabetics with depression had a significantly worse non-discriminative touch (p < 0.05) and vibratory sensation when tested with a tuning fork (p < 0.05). In addition, poorer QoL was associated with reduced sensitivity to heat (p < 0.05), light touch pressure (p < 0.05), and vibrations when assessed either with a tuning fork (p < 0.05) or a biothesiometer (p < 0.05). In contrast, no relationships were found between sensory functions and cognitive assessments in non-diabetic patients. These findings indicate that superficial sensitivity damage was related to CI, while deep sensation alterations were related to depression and poor QoL, with diabetes apparently further strengthening these relationships.
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Affiliation(s)
- Mar Sempere-Bigorra
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Iván Julián-Rochina
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Pilar Pérez-Ros
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Emmanuel Navarro-Flores
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Francisco Miguel Martínez-Arnau
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Omar Cauli
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
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van den Berg E, Vernooij MW, Mattace‐Raso FU, Wolters FJ. Sharpening the tools for the assessment of vascular cognitive impairment. Alzheimers Dement 2022; 19:1587-1588. [PMID: 36416073 DOI: 10.1002/alz.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Meike W. Vernooij
- Department of Radiology & Nuclear Medicine and Alzheimer Center Erasmus MC Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Francesco U.S. Mattace‐Raso
- Department of Geriatrics and Alzheimer Center Erasmus MC Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Frank J. Wolters
- Department of Radiology & Nuclear Medicine and Alzheimer Center Erasmus MC Erasmus MC University Medical Center Rotterdam the Netherlands
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands
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