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Clancy U, Kancheva AK, Valdés Hernández MDC, Jochems ACC, Muñoz Maniega S, Quinn TJ, Wardlaw JM. Imaging Biomarkers of VCI: A Focused Update. Stroke 2024; 55:791-800. [PMID: 38445496 DOI: 10.1161/strokeaha.123.044171] [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] [Indexed: 03/07/2024]
Abstract
Vascular cognitive impairment is common after stroke, in memory clinics, medicine for the elderly services, and undiagnosed in the community. Vascular disease is said to be the second most common cause of dementia after Alzheimer disease, yet vascular dysfunction is now known to predate cognitive decline in Alzheimer disease, and most dementias at older ages are mixed. Neuroimaging has a major role in identifying the proportion of vascular versus other likely pathologies in patients with cognitive impairment. Here, we aim to provide a pragmatic but evidence-based summary of the current state of potential imaging biomarkers, focusing on magnetic resonance imaging and computed tomography, which are relevant to diagnosing, estimating prognosis, monitoring vascular cognitive impairment, and incorporating our own experiences. We focus on markers that are well-established, with a known profile of association with cognitive measures, but also consider more recently described, including quantitative tissue markers of vascular injury. We highlight the gaps in accessibility and translation to more routine clinical practice.
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Affiliation(s)
- Una Clancy
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Angelina K Kancheva
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (A.K.K., T.J.Q.)
| | - Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Angela C C Jochems
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (A.K.K., T.J.Q.)
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
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Chen DH, Huang JR, Su SL, Chen Q, Wu BY. Therapeutic potential of mesenchymal stem cells for cerebral small vessel disease. Regen Ther 2024; 25:377-386. [PMID: 38414558 PMCID: PMC10899004 DOI: 10.1016/j.reth.2023.11.002] [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: 08/23/2023] [Revised: 10/12/2023] [Accepted: 11/05/2023] [Indexed: 02/29/2024] Open
Abstract
Cerebral small vessel disease (CSVD), as the most common, chronic and progressive vascular disease on the brain, is a serious neurological disease, whose pathogenesis remains unclear. The disease is a leading cause of stroke and vascular cognitive impairment and dementia, and contributes to about 20% of strokes, including 25% of ischemic strokes and 45% of dementias. Undoubtedly, the high incidence and poor prognosis of CSVD have brought a heavy economic and medical burden to society. The present treatment of CSVD focuses on the management of vascular risk factors. Although vascular risk factors may be important causes or accelerators of CSVD and should always be treated in accordance with best clinical practice, controlling risk factors alone could not curb the progression of CSVD brain injury. Therefore, developing safer and more effective treatment strategies for CSVD is urgently needed. Recently, mesenchymal stem cells (MSCs) therapy has become an emerging therapeutic modality for the treatment of central nervous system disease, given their paracrine properties and immunoregulatory. Herein, we discussed the therapeutic potential of MSCs for CSVD, aiming to enable clinicians and researchers to understand of recent progress and future directions in the field.
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Affiliation(s)
- Dong-Hua Chen
- Neurology Department, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
| | - Jia-Rong Huang
- Neurology Department, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
| | - Shuo-Lei Su
- Shaoguan University, No.288 University Road, Xinshaozhen Zhenjiang District, Shaoguan, 512005, China
| | - Qiong Chen
- Medical Research center of Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
- Precision Medicine Center of Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
| | - Bing-Yi Wu
- Medical Research center of Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
- Precision Medicine Center of Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, China
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Zhao B, Jia W, Yuan Y, Li Z, Fu X. Effects of intensive blood pressure control on cognitive function in patients with cerebral small vessel disease. J Stroke Cerebrovasc Dis 2023; 32:107289. [PMID: 37544058 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107289] [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: 01/26/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the effects of intensive blood pressure control on cognitive function in elderly patients with cerebral small vessel disease (CSVD). METHODS From May 2020 to June 2022, 140 outpatients and inpatients with CSVD and hypertension in the Department of Neurology of Beijing Shijingshan Hospital were selected. They were randomly divided into the standard and intensive blood pressure control groups, and the dosage of antihypertensive drugs was adjusted to reduce the blood pressure to the target level. The patients were followed up for 2 years. The medical records or data at "enrollment" and "2-year follow-up" were analyzed and evaluated. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive function. Cranial magnetic resonance imaging was performed to evaluate lacunar infarctions (LIs) and white matter hyperintensity (WMH). Multiple linear regression was used to analyze the correlation between MMSE scores and blood pressure, WMH, and LIs. RESULTS (1) The MMSE and MoCA scores in the standard group were significantly lower than those at enrollment. The WMH score in the standard group was significantly higher than that at enrollment. (2) After the 2-year follow-up, the 24-h systolic blood pressure (SBP), 24-h diastolic blood pressure (DBP), daytime mean SBP, daytime mean DBP, and nighttime mean SBP in the two groups significantly decreased, which had significant statistical significance (P < 0.05). (3) The correlation between blood pressure and MMSE score was analyzed using multiple linear regression analysis. The WMH score, LIs, 24-h SBP, and 24-h DBP were independently correlated with MMSE scores. CONCLUSION In elderly patients with hypertension, a decrease in SBP to 126 mmHg, compared with 134 mmHg, can delay cognitive impairment as well as reduce LIs and cerebral WMH lesions in patients with CSVD.
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Affiliation(s)
- Bingqing Zhao
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, China.
| | - Weihua Jia
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, China
| | - Ye Yuan
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, China
| | - Zheng Li
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, China
| | - Xinran Fu
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, China
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Zedde M, Napoli M, Grisendi I, Assenza F, Moratti C, Valzania F, Pascarella R. Perfusion Status in Lacunar Stroke: A Pathophysiological Issue. Diagnostics (Basel) 2023; 13:2003. [PMID: 37370898 DOI: 10.3390/diagnostics13122003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/16/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The pathophysiology of lacunar infarction is an evolving and debated field, where relevant information comes from histopathology, old anatomical studies and animal models. Only in the last years, have neuroimaging techniques allowed a sufficient resolution to directly or indirectly assess the dynamic evolution of small vessel occlusion and to formulate hypotheses about the tissue status and the mechanisms of damage. The core-penumbra concept was extensively explored in large vessel occlusions (LVOs) both from the experimental and clinical point of view. Then, the perfusion thresholds on one side and the neuroimaging techniques studying the perfusion of brain tissue were focused and optimized for LVOs. The presence of a perfusion deficit in the territory of a single small perforating artery was negated for years until the recent proposal of the existence of a perfusion defect in a subgroup of lacunar infarcts by using magnetic resonance imaging (MRI). This last finding opens pathophysiological hypotheses and triggers a neurovascular multidisciplinary reasoning about how to image this perfusion deficit in the acute phase in particular. The aim of this review is to summarize the pathophysiological issues and the application of the core-penumbra hypothesis to lacunar stroke.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
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Lin B, Mu Y, Ding Z. Assessing the Causal Association between Biological Aging Biomarkers and the Development of Cerebral Small Vessel Disease: A Mendelian Randomization Study. Biology (Basel) 2023; 12:biology12050660. [PMID: 37237474 DOI: 10.3390/biology12050660] [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] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/09/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
Biological aging biomarkers, such as leukocyte telomere length (LTL) and epigenetic clocks, have been associated with the risk of cerebral small vessel disease (CSVD) in several observational studies. However, it is unclear whether LTL or epigenetic clocks play causal roles as prognostic biomarkers in the development of CSVD. We performed a Mendelian randomization (MR) study of LTL and four epigenetic clocks on ten subclinical and clinical CSVD measures. We obtained genome-wide association (GWAS) data for LTL from the UK Biobank (N = 472,174). Data on epigenetic clocks were derived from a meta-analysis (N = 34,710), and CSVD data (N cases =1293-18,381; N controls = 25,806-105,974) were extracted from the Cerebrovascular Disease Knowledge Portal. We found that genetically determined LTL and epigenetic clocks were not individually associated with ten measures of CSVD (IVW p > 0.05), and this result was consistent across sensitivity analyses. Our findings imply that LTL and epigenetic clocks may not help in predicting CSVD development as causal prognostic biomarkers. Further studies are needed to illustrate the potential of reverse biological aging in serving as an effective form of preventive therapy for CSVD.
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Affiliation(s)
- Biying Lin
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Rd., Hangzhou 310006, China
| | - Yuzhu Mu
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Rd., Hangzhou 310006, China
- Department of Radiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Zhongxiang Ding
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Rd., Hangzhou 310006, China
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Carmichael ST, Llorente IL. The Ties That Bind: Glial Transplantation in White Matter Ischemia and Vascular Dementia. Neurotherapeutics 2023; 20:39-47. [PMID: 36357662 PMCID: PMC10119342 DOI: 10.1007/s13311-022-01322-8] [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] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
White matter injury is a progressive vascular disease that leads to neurological deficits and vascular dementia. It comprises up to 30% of all diagnosed strokes, though up to ten times as many events go undiagnosed in early stages. There are several pathologies that can lead to white matter injury. While some studies suggest that white matter injury starts as small infarcts in deep penetrating blood vessels in the brain, others point to the breakdown of endothelial function or the blood-brain barrier as the primary cause of the disease. Whether due to local endothelial or BBB dysfunction, or to local small infarcts (or a combination), white matter injury progresses, accumulates, and expands from preexisting lesions into adjacent white matter to produce motor and cognitive deficits that present as vascular dementia in the elderly. Vascular dementia is the second leading cause of dementia, and white matter injury-attributed vascular dementia represents 40% of all diagnosed dementias and aggravates Alzheimer's pathology. Despite the advances in the last 15 years, there are few animal models of progressive subcortical white matter injury or vascular dementia. This review will discuss recent progress in animal modeling of white matter injury and the emerging principles to enhance glial function as a means of promoting repair and recovery.
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Affiliation(s)
- S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, 635 Charles E Young Drive South, NRB 407, Los Angeles, CA, 90095, USA
| | - Irene L Llorente
- Department of Neurosurgery, Stanford University, 3801 Miranda Ave, 94304, Palo alto, USA.
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Vikner T, Karalija N, Eklund A, Malm J, Lundquist A, Gallewicz N, Dahlin M, Lindenberger U, Riklund K, Bäckman L, Nyberg L, Wåhlin A. 5-Year Associations among Cerebral Arterial Pulsatility, Perivascular Space Dilation, and White Matter Lesions. Ann Neurol 2022; 92:871-881. [PMID: 36054261 PMCID: PMC9804392 DOI: 10.1002/ana.26475] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE High cerebral arterial pulsatility index (PI), white matter lesions (WMLs), enlarged perivascular spaces (PVSs), and lacunar infarcts are common findings in the elderly population, and considered indicators of small vessel disease (SVD). Here, we investigate the potential temporal ordering among these variables, with emphasis on determining whether high PI is an early or delayed manifestation of SVD. METHODS In a population-based cohort, 4D flow MRI data for cerebral arterial pulsatility was collected for 159 participants at baseline (age 64-68), and for 122 participants at follow-up 5 years later. Structural MRI was used for WML and PVS segmentation, and lacune identification. Linear mixed-effects (LME) models were used to model longitudinal changes testing for pairwise associations, and latent change score (LCS) models to model multiple relationships among variables simultaneously. RESULTS Longitudinal 5-year increases were found for WML, PVS, and PI. Cerebral arterial PI at baseline did not predict changes in WML or PVS volume. However, WML and PVS volume at baseline predicted 5-year increases in PI. This was shown for PI increases in relation to baseline WML and PVS volumes using LME models (R ≥ 0.24; p < 0.02 and R ≥ 0.23; p < 0.03, respectively) and LCS models ( β = 0.28; p = 0.015 and β = 0.28; p = 0.009, respectively). Lacunes at baseline were unrelated to PI. INTERPRETATION In healthy older adults, indicators of SVD are related in a lead-lag fashion, in which the expression of WML and PVS precedes increases in cerebral arterial PI. Hence, we propose that elevated PI is a relatively late manifestation, rather than a risk factor, for cerebral SVD. ANN NEUROL 2022;92:871-881.
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Affiliation(s)
- Tomas Vikner
- Department of Radiation SciencesUmeå UniversityUmeåSweden
| | - Nina Karalija
- Department of Radiation SciencesUmeå UniversityUmeåSweden
- Umeå Center for Functional Brain Imaging (UFBI)Umeå UniversityUmeåSweden
| | - Anders Eklund
- Department of Radiation SciencesUmeå UniversityUmeåSweden
- Umeå Center for Functional Brain Imaging (UFBI)Umeå UniversityUmeåSweden
| | - Jan Malm
- Department of Clinical Science, NeurosciencesUmeå UniversityUmeåSweden
| | - Anders Lundquist
- Umeå Center for Functional Brain Imaging (UFBI)Umeå UniversityUmeåSweden
- Department of Statistics, USBEUmeå UniversityUmeåSweden
| | | | - Magnus Dahlin
- Department of Radiation SciencesUmeå UniversityUmeåSweden
| | - Ulman Lindenberger
- Center for Lifespan PsychologyMax Planck Institute for Human DevelopmentBerlinGermany
- Max PlanckUCL Centre for Computational Psychiatry and Ageing ResearchBerlinGermany
- Max PlanckUCL Centre for Computational Psychiatry and Ageing ResearchLondonUK
| | - Katrine Riklund
- Department of Radiation SciencesUmeå UniversityUmeåSweden
- Umeå Center for Functional Brain Imaging (UFBI)Umeå UniversityUmeåSweden
| | - Lars Bäckman
- Ageing Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
| | - Lars Nyberg
- Department of Radiation SciencesUmeå UniversityUmeåSweden
- Umeå Center for Functional Brain Imaging (UFBI)Umeå UniversityUmeåSweden
- Department of Integrative Medical Biology (IMB)Umeå UniversityUmeåSweden
| | - Anders Wåhlin
- Department of Radiation SciencesUmeå UniversityUmeåSweden
- Umeå Center for Functional Brain Imaging (UFBI)Umeå UniversityUmeåSweden
- Department of Applied Physics and ElectronicsUmeå UniversityUmeåSweden
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Wang S, Zhang F, Huang P, Hong H, Jiaerken Y, Yu X, Zhang R, Zeng Q, Zhang Y, Kikinis R, Rathi Y, Makris N, Lou M, Pasternak O, Zhang M, O'Donnell LJ. Superficial white matter microstructure affects processing speed in cerebral small vessel disease. Hum Brain Mapp 2022; 43:5310-5325. [PMID: 35822593 PMCID: PMC9812245 DOI: 10.1002/hbm.26004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 01/15/2023] Open
Abstract
White matter hyperintensities (WMH) are a typical feature of cerebral small vessel disease (CSVD), which contributes to about 50% of dementias worldwide. Microstructural alterations in deep white matter (DWM) have been widely examined in CSVD. However, little is known about abnormalities in superficial white matter (SWM) and their relevance for processing speed, the main cognitive deficit in CSVD. In 141 CSVD patients, processing speed was assessed using Trail Making Test Part A. White matter abnormalities were assessed by WMH burden (volume on T2-FLAIR) and diffusion MRI measures. SWM imaging measures had a large contribution to processing speed, despite a relatively low SWM WMH burden. Across all imaging measures, SWM free water (FW) had the strongest association with processing speed, followed by SWM mean diffusivity (MD). SWM FW was the only marker to significantly increase between two subgroups with the lowest WMH burdens. When comparing two subgroups with the highest WMH burdens, the involvement of WMH in the SWM was accompanied by significant differences in processing speed and white matter microstructure. Mediation analysis revealed that SWM FW fully mediated the association between WMH volume and processing speed, while no mediation effect of MD or DWM FW was observed. Overall, results suggest that the SWM has an important contribution to processing speed, while SWM FW is a sensitive imaging marker associated with cognition in CSVD. This study extends the current understanding of CSVD-related dysfunction and suggests that the SWM, as an understudied region, can be a potential target for monitoring pathophysiological processes.
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Affiliation(s)
- Shuyue Wang
- Department of Radiologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina,Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Fan Zhang
- Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Peiyu Huang
- Department of Radiologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina
| | - Hui Hong
- Department of Radiologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina
| | - Yeerfan Jiaerken
- Department of Radiologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina
| | - Xinfeng Yu
- Department of Radiologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina
| | - Ruiting Zhang
- Department of Radiologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina
| | - Qingze Zeng
- Department of Radiologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina
| | - Yao Zhang
- Department of Radiologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina
| | - Ron Kikinis
- Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Yogesh Rathi
- Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Nikos Makris
- Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA,Center for Morphometric AnalysisMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Min Lou
- Department of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina
| | - Ofer Pasternak
- Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Minming Zhang
- Department of Radiologythe Second Affiliated Hospital of Zhejiang University School of MedicineChina
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Mitroi DN, Tian M, Kawaguchi R, Lowry WE, Carmichael ST. Single-nucleus transcriptome analysis reveals disease- and regeneration-associated endothelial cells in white matter vascular dementia. J Cell Mol Med 2022; 26:3183-3195. [PMID: 35543222 PMCID: PMC9170821 DOI: 10.1111/jcmm.17315] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/01/2022] [Accepted: 03/12/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vascular dementia (VaD) is the accumulation of vascular lesions in the subcortical white matter of the brain. These lesions progress and there is no direct medical therapy. AIMS To determine the specific cellular responses in VaD so as to provide molecular targets for therapeutic development. MATERIALS AND METHODS Single-nucleus transcriptome analysis was performed in human periventricular white matter (PVWM) samples of VaD and normal control (NC) subjects. RESULTS Differential analysis shows that cell type-specific transcriptomic changes in VaD are associated with the disruption of specific biological processes, including angiogenesis, immune activation, axonal injury and myelination. Each cell type in the neurovascular unit within white matter has a specific alteration in gene expression in VaD. In a central cell type for this disease, subcluster analysis of endothelial cells (EC) indicates that VaD contains a disease-associated EC subcluster that expresses genes associated with programmed cell death and a response to protein folding. Two other subpopulations of EC in VaD express molecular systems associated with regenerative processes in angiogenesis, and in axonal sprouting and oligodendrocyte progenitor cell maturation. CONCLUSION This comprehensive molecular profiling of brain samples from patients with VaD reveals previously unknown molecular changes in cells of the neurovascular niche, and an attempt at regeneration in injured white matter.
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Affiliation(s)
- Daniel N. Mitroi
- Department of Psychiatry and Biobehavioral SciencesDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Min Tian
- Department of Psychiatry and Biobehavioral SciencesDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Riki Kawaguchi
- Department of Psychiatry and Biobehavioral SciencesDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - William E. Lowry
- Department of Molecular, Cell and Developmental BiologyUCLALos AngelesCaliforniaUSA
| | - S. Thomas Carmichael
- Department of Psychiatry and Biobehavioral SciencesDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
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Cai M, Jacob MA, van Loenen MR, Bergkamp M, Marques J, Norris DG, Duering M, Tuladhar AM, de Leeuw FE. Determinants and Temporal Dynamics of Cerebral Small Vessel Disease: 14-Year Follow-Up. Stroke 2022; 53:2789-2798. [PMID: 35506383 PMCID: PMC9389939 DOI: 10.1161/strokeaha.121.038099] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study is to investigate the temporal dynamics of small vessel disease (SVD) and the effect of vascular risk factors and baseline SVD burden on progression of SVD with 4 neuroimaging assessments over 14 years in patients with SVD. METHODS Five hundred three patients with sporadic SVD (50-85 years) from the ongoing prospective cohort study (RUN DMC [Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort]) underwent baseline assessment in 2006 and follow-up in 2011, 2015, and 2020. Vascular risk factors and magnetic resonance imaging markers of SVD were evaluated. Linear mixed-effects model and negative binomial regression model were used to examine the determinants of temporal dynamics of SVD markers. RESULTS A total of 382 SVD patients (mean [SD] 64.1 [8.4]; 219 men and 163 women) who underwent at least 2 serial brain magnetic resonance imaging scans were included, with mean (SD) follow-up of 11.15 (3.32) years. We found a highly variable temporal course of SVD. Mean (SD) WMH progression rate was 0.6 (0.74) mL/y (range, 0.02-4.73 mL/y) and 13.6% of patients had incident lacunes (1.03%/y) over the 14-year follow-up. About 4% showed net WMH regression over 14 years, whereas 38 out of 361 (10.5%), 5 out of 296 (2%), and 61 out of 231 (26%) patients showed WMH regression for the intervals 2006 to 2011, 2011 to 2015, and 2015 to 2020, respectively. Of these, 29 (76%), 5 (100%), and 57 (93%) showed overall progression across the 14-year follow-up, and the net overall WMH change between first and last scan considering all participants was a net average WMH progression over the 14-year period. Older age was a strong predictor for faster WMH progression and incident lacunes. Patients with mild baseline WMH rarely progressed to severe WMH. In addition, both baseline burden of SVD lesions and vascular risk factors independently and synergistically predicted WMH progression, whereas only baseline SVD burden predicted incident lacunes over the 14-year follow-up. CONCLUSIONS SVD shows pronounced progression over time, but mild WMH rarely progresses to clinically severe WMH. WMH regression is noteworthy during some magnetic resonance imaging intervals, although it could be overall compensated by progression over the long follow-up.
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Affiliation(s)
- Mengfei Cai
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Nijmegen, the Netherlands. (M.C., M.A.J., M.B., A.M.T., F.-E.d.L.)
| | - Mina A Jacob
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Nijmegen, the Netherlands. (M.C., M.A.J., M.B., A.M.T., F.-E.d.L.)
| | - Mark R van Loenen
- Center for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour; Nijmegen, the Netherlands. (M.R.v.L., J.M., D.G.N.)
| | - Mayra Bergkamp
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Nijmegen, the Netherlands. (M.C., M.A.J., M.B., A.M.T., F.-E.d.L.)
| | - José Marques
- Center for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour; Nijmegen, the Netherlands. (M.R.v.L., J.M., D.G.N.)
| | - David G Norris
- Center for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour; Nijmegen, the Netherlands. (M.R.v.L., J.M., D.G.N.)
| | - Marco Duering
- Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Switzerland (M.D.)
| | - Anil M Tuladhar
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Nijmegen, the Netherlands. (M.C., M.A.J., M.B., A.M.T., F.-E.d.L.)
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Nijmegen, the Netherlands. (M.C., M.A.J., M.B., A.M.T., F.-E.d.L.)
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11
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Jiang J, Yao K, Huang X, Zhang Y, Shen F, Weng S. Longitudinal white matter hyperintensity changes and cognitive decline in patients with minor stroke. Aging Clin Exp Res 2022; 34:1047-1054. [PMID: 35084664 PMCID: PMC9135882 DOI: 10.1007/s40520-021-02024-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
Background and objective As reported, both minor stroke and white matter hyperintensities (WMHs) are associated with an increased risk of cognitive impairment and dementia. The underlying factors for dynamic changes in WMH volume and cognitive performances in patients with minor stroke remain poorly understood. A 2-year longitudinal study was designed to investigate the factors associated with the changes in white matter hyperintensity (WMH) volume on brain MRI and cognitive decline in patients with minor stroke. Methods A group of eligible patients with minor ischemic stroke was recruited in a row. At the initial and 2-year follow-up visits, all the participants underwent routine examinations, multimodal MRI, and cognitive assessment. Using a lesion prediction algorithm tool, we were able to automate the measurement of the change in WMH volume. During the 2-year follow-up, cognitive function was evaluated using Telephone Interview for Cognitive Status-Modified (TICS-m). Participants’ demographic, clinical, and therapeutic data were collected and statistically analyzed. Regression analyses were used to test the relationships between risk factors and changes in WMH volume and cognitive decline. Results Finally, we followed up with 225/261 participants for 2 years, with a mean age of 65.67 ± 10.73 years (65.6% men). WMH volume was observed to be increased in 113 patients, decreased in 74 patients, and remained stable in 58 patients. Patients with WMH progression were more often had a history of hypertension (p = 0.006) and a higher CSVD burden both at baseline and follow-up visit (p < 0.05). Longitudinally, the proportion of patients taking antihypertension medications on a regular basis in the regression group was higher than in the stable group (p = 0.01). When compared to the stable group, the presence of lacunes (OR 9.931, 95% CI 1.597–61.77, p = 0.014) was a stronger predictor of progression in WMH volume. 87 subjects (38.6%) displayed incident cognitive impairment. The progression of WMH volume was a significant risk factor for cognitive decline (p < 0.001). Conclusions The longitudinal change of WMH is dynamic. The regressive WMH volume was associated with the use of antihypertensive medications on a regular basis. The presence of lacunes at the initial visit of the study was a stronger predictor of WMH progression. The progression of WMH volume could be useful in predicting cognitive decline in patients with minor stroke.
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Affiliation(s)
- Jingwen Jiang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kanmin Yao
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Huang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fanxia Shen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Suiqing Weng
- Department of Neurology, Shanghai Minhang Hospital, Shanghai Fu Dan University, Shanghai, China.
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12
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Hu YH, Halstead MR, Bryan RN, Schreiner PJ, Jacobs DR, Sidney S, Lewis CE, Launer LJ. Association of Early Adulthood 25-Year Blood Pressure Trajectories With Cerebral Lesions and Brain Structure in Midlife. JAMA Netw Open 2022; 5:e221175. [PMID: 35267035 PMCID: PMC8914577 DOI: 10.1001/jamanetworkopen.2022.1175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Midlife elevated blood pressure (BP) is an important risk factor associated with brain structure and function. Little is known about trajectories of BP that modulate this risk. OBJECTIVE To identify BP trajectory patterns from young adulthood to midlife that are associated with brain structure in midlife. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data of US adults from Coronary Artery Risk Development in Young Adults (CARDIA), a prospective longitudinal study of Black and White men and women (baseline age 18 to 30 years) examined up to 8 times over 30 years (1985-1986 to 2015-2016). There were 885 participants who underwent brain magnetic resonance imaging (MRI) in the 25th or 30th year examinations. Analyses were conducted November 2019 to December 2020. EXPOSURES Using group-based trajectory modeling, 5 25-year BP trajectories for 3 BP traits were identified in the total CARDIA cohort of participants with 3 or more BP measures, which were then applied to analyses of the subset of 853 participants in the Brain MRI substudy. Mean arterial pressure (MAP) was examined as an integrative measure of systolic and diastolic BP. With linear regression, the associations of the BP trajectories with brain structures were examined, adjusting sequentially for demographics, cardiovascular risk factors, and antihypertensive medication use. MAIN OUTCOMES AND MEASURES Brain MRI outcomes include total brain, total gray matter, normal-looking and abnormal white matter volumes, gray matter cerebral blood flow, and white matter fractional anisotropy. RESULTS Brain MRI analyses were conducted on 853 participants (mean [SD] age, 50.3 [3.6] years; 399 [46.8%] men; 354 [41.5%] Black and 499 [58.5%] White individuals). The MAP trajectory distribution was 187 individuals (21.1%) with low-stable, 385 (43.5%) with moderate-gradual, 71 (8.0%) with moderate-increasing, 204 (23.1%) with elevated-stable, and 38 (4.3%) with elevated-increasing. Compared with the MAP low-stable trajectory group, individuals in the moderate-increasing and elevated-increasing groups were more likely to have higher abnormal white matter volume (moderate: β, 0.52; 95% CI, 0.23 to 0.82; elevated: β, 0.57; 95% CI, 0.19 to 0.95). Those in the MAP elevated-increasing group had lower gray matter cerebral blood flow (β, -0.42; 95% CI, -0.79 to -0.05) after adjusting for sociodemographics and cardiovascular risk factors. After adjustment for antihypertensive medication use, the difference was consistent for abnormal white matter volume, but results were no longer significant for gray matter cerebral blood flow. CONCLUSIONS AND RELEVANCE Among young adults with moderate to high levels of BP, a gradual increase in BP to middle-age may increase the risk in diffuse small vessel disease and lower brain perfusion.
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Affiliation(s)
- Yi-Han Hu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland
| | - Michael R. Halstead
- Division of Neurocritical Care, Sentara Pulmonary, Critical Care, and Sleep Specialists, Norfolk, Virginia
| | - R. Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Stephen Sidney
- Kaiser Permanente Medical Center Program, Oakland, California
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland
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13
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Whitehead SN, Bruno A, Burns JM, Carmichael ST, Csiszar A, Edwards JD, Elahi FM, Faraco G, Gould DB, Gustafson DR, Hachinski V, Rosenberg G, Sorond FA, Shih AY, Tse KH, Ungvari Z, Wilcock DM, Zuloaga KL, Barone FC. Expanding the horizon of research into the pathogenesis of the white matter diseases: Proceedings of the 2021 Annual Workshop of the Albert Research Institute for White Matter and Cognition. GeroScience 2022; 44:25-37. [PMID: 34606040 PMCID: PMC8488071 DOI: 10.1007/s11357-021-00461-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
White matter pathologies are critically involved in the etiology of vascular cognitive impairment-dementia (VCID), Alzheimer's disease (AD), and Alzheimer's disease and related diseases (ADRD), and therefore need to be considered a treatable target ( Roseborough A, Hachinski V, Whitehead S. White matter degeneration - a treatable target? Roseborough et al. JAMA Neurol [Internet]. 2020 Apr 27;77(7):793-4, [1] . To help address this often-missed area of research, several workshops have been sponsored by the Leo and Anne Albert Charitable Trust since 2015, resulting in the incorporation of "The Albert Research Institute for White Matter and Cognition" in 2020. The first annual "Institute" meeting was held virtually on March 3-4, 2021. The Institute provides a forum and workspace for communication and support of the advancement of white matter science and research to better understand the evolution and prevention of dementia. It serves as a platform for young investigator development, to introduce new data and debate biology mechanisms and new ideas, and to encourage and support new research collaborations and directions to clarify how white matter changes, with other genetic and health risk factors, contribute to cognitive impairment. Similar to previous Albert Trust-sponsored workshops (Barone et al. in J Transl Med 14:1-14, [2]; Sorond et al. in GeroScience 42:81-96, [3]), established expert investigators were identified and invited to present. Opportunities to attend and present were also extended by invitation to talented research fellows and younger scientists. Also, updates on institute-funded research collaborations were provided and discussed. The summary that follows is a synopsis of topics and discussion covered in the workshop.
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Affiliation(s)
- Shawn N Whitehead
- Department of Anatomy and Cell Biology, Western University, London, ON, N6A 3K7, Canada.
| | - Askiel Bruno
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, 30912, USA
| | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Jodi D Edwards
- University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, K1G 5Z3, Canada
| | - Fanny M Elahi
- Memory and Aging Center, UCSF Weill Institute for Neurosciences, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158, USA
| | - Giuseppe Faraco
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Douglas B Gould
- Departments of Ophthalmology and Anatomy, and Institute for Human Genetics, School of Medicine, University of California, San Francisco, 94143, USA
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York Downstate Health Sciences University, New York, Brooklyn, 11203, USA
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON, N6A 5C1, Canada
| | - Gary Rosenberg
- UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, 87106, USA
| | | | - Andy Y Shih
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute; Department of Pediatrics; Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kai Hei Tse
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Donna M Wilcock
- Sanders-Brown Center on Aging; Department of Neurology, Department of Behavioral Science, University of Kentucky, Lexington, KY, 40536, USA
| | - Kristen L Zuloaga
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, 12208, USA
| | - Frank C Barone
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, 11203, USA
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14
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Clancy U, Ramirez J, Chappell FM, Doubal FN, Wardlaw JM, Black SE. Neuropsychiatric symptoms as a sign of small vessel disease progression in cognitive impairment. Cereb Circ Cogn Behav 2022; 3:100041. [PMID: 36324402 PMCID: PMC9616231 DOI: 10.1016/j.cccb.2022.100041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/29/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/27/2022]
Abstract
Background Neuropsychiatric symptoms associate cross-sectionally with cerebral small vessel disease but it is not clear whether these symptoms could act as early clinical markers of small vessel disease progression. We investigated whether longitudinal change in Neuropsychiatric Inventory (NPI) scores associated with white matter hyperintensity (WMH) progression in a memory clinic population. Material and methods We included participants from the prospective Sunnybrook Dementia Study with Alzheimer's disease and vascular subtypes of mild cognitive impairment and dementia with two MRI and ≥ 1 NPI. We conducted linear mixed-effects analyses, adjusting for age, atrophy, vascular risk factors, cognition, function, and interscan interval. Results At baseline (n=124), greater atrophy, age, vascular risk factors and total NPI score were associated with higher baseline WMH volume, while longitudinally, all but vascular risk factors were associated. Change in total NPI score was associated with change in WMH volume, χ2 = 7.18, p = 0.007, whereby a one-point change in NPI score from baseline to follow-up was associated with a 0.0017 change in normalized WMH volume [expressed as cube root of (WMH volume cm³ as % intracranial volume)], after adjusting for age, atrophy, vascular risk factors and interscan interval. Conclusions In memory clinic patients, WMH progression over 1-2 years associated with worsening neuropsychiatric symptoms, while WMH volume remained unchanged in those with stable NPI scores in this population with low background WMH burden.
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Affiliation(s)
- Una Clancy
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Joel Ramirez
- Dr. Sandra Black Centre for Brain Resilience & Recovery, LC Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada,Corresponding author.
| | - Francesca M. Chappell
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Fergus N. Doubal
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Joanna M. Wardlaw
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Sandra E. Black
- Dr. Sandra Black Centre for Brain Resilience & Recovery, LC Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
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15
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Hotz I, Deschwanden PF, Mérillat S, Liem F, Kollias S, Jäncke L. Associations of subclinical cerebral small vessel disease and processing speed in non-demented subjects: A 7-year study. Neuroimage Clin 2021; 32:102884. [PMID: 34911190 PMCID: PMC8633374 DOI: 10.1016/j.nicl.2021.102884] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 12/22/2022]
Abstract
Markers of cerebral small vessel disease (CSVD) have previously been associated with age-related cognitive decline. Using longitudinal data of cognitively healthy, older adults (N = 216, mean age at baseline = 70.9 years), we investigated baseline status and change in white matter hyperintensities (WMH) (total, periventricular, deep), normal appearing white matter (NAWM), brain parenchyma volume (BPV) and processing speed over seven years as well as the impact of different covariates by applying latent growth curve (LGC) models. Generally, we revealed a complex pattern of associations between the different CSVD markers. More specifically, we observed that changes of deep WMH (dWMH), as compared to periventricular WMH (pWMH), were more strongly related to the changes of other CSVD markers and also to baseline processing speed performance. Further, the number of lacunes rather than their volume reflected the severity of CSVD. With respect to the studied covariates, we revealed that higher education had a protective effect on subsequent total WMH, pWMH, lacunar number, NAWM volume, and processing speed performance. The indication of antihypertensive drugs was associated with lower lacunar number and volume at baseline and the indication of antihypercholesterolemic drugs came along with higher processing speed performance at baseline. In summary, our results confirm previous findings, and extend them by providing information on true within-person changes, relationships between the different CSVD markers and brain-behavior associations. The moderate to strong associations between changes of the different CSVD markers indicate a common pathological relationship and, thus, support multidimensional treatment strategies.
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Affiliation(s)
- Isabel Hotz
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland; University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.
| | - Pascal Frédéric Deschwanden
- University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Susan Mérillat
- University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Franziskus Liem
- University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Spyridon Kollias
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland; University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.
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16
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Gyanwali B, Lui B, Tan CS, Chong EJY, Vrooman H, Chen C, Hilal S. Cerebral Microbleeds and White Matter Hyperintensities are Associated with Cognitive Decline in an Asian Memory Clinic Study. Curr Alzheimer Res 2021; 18:399-413. [PMID: 34420506 DOI: 10.2174/1567205018666210820125543] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/14/2020] [Revised: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebral Small Vessel Disease (SVD); lacunes, Cerebral Microbleeds (CMBs), and White Matter Hyperintensities (WMH) have a vital role in cognitive impairment and dementia. SVD in lobar location is related to cerebral amyloid angiopathy, whereas SVD in a deep location with hypertensive arteriopathy. It remains unclear how different locations of SVD affect long-term cognitive decline. The present study aimed to analyse the association between different locations and severity of SVD with global and domain-specific cognitive decline over the follow-up interval of 3 years. METHODS We studied 428 participants who had performed MRI scans at baseline and at least 3 neuropsychological assessments. Locations of lacunes and CMBs were categorized into strictly lobar, strictly deep and mixed-location, WMH volume into anterior and posterior. The National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Harmonization Neuropsychological Battery was used to assess cognitive function. To analyse the association between baseline location and severity of SVD with cognitive decline, linear regression models with generalized estimated equations were constructed to calculate the mean difference, 95% confidence interval and two-way interaction factor between time and SVD. RESULTS Increased numbers of baseline CMBs were associated with a decline in global cognition as well as a decline in executive function and memory domains. Location-specific analysis showed similar results with strictly lobar CMBs. There was no association with strictly deep and mixed-location CMBs with cognitive decline. Baseline WMH volume was associated with a decline in global cognition, executive function and memory. Similar results were obtained with anterior and posterior WMH volumes. Lacunes and their locations were not associated with cognitive decline. CONCLUSION Strictly lobar CMBs, as well as WMH volume in anterior and posterior regions, were associated with cognitive decline. Future research focuses are warranted to evaluate interventions that may prevent cognitive decline related to SVD.
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Affiliation(s)
- Bibek Gyanwali
- Memory Aging & Cognition Centre, National University Health System, 21 Lower Kent Ridge Rd, Singapore
| | - Benedict Lui
- Memory Aging & Cognition Centre, National University Health System, 21 Lower Kent Ridge Rd, Singapore
| | - Chuen S Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 21 Lower Kent Ridge Rd, Singapore
| | - Eddie J Y Chong
- Department of Psychological Medicine, National University Hospital, 21 Lower Kent Ridge Rd, Singapore
| | - Henri Vrooman
- Departments of Radiology & Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christopher Chen
- Memory Aging & Cognition Centre, National University Health System, 21 Lower Kent Ridge Rd, Singapore
| | - Saima Hilal
- Memory Aging & Cognition Centre, National University Health System, 21 Lower Kent Ridge Rd, Singapore
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Empana JP, Boutouyrie P, Lemogne C, Jouven X, van Sloten TT. Microvascular Contribution to Late-Onset Depression: Mechanisms, Current Evidence, Association With Other Brain Diseases, and Therapeutic Perspectives. Biol Psychiatry 2021; 90:214-225. [PMID: 34325805 DOI: 10.1016/j.biopsych.2021.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022]
Abstract
Depression is common in older individuals and is associated with high disability and mortality. A major problem is treatment resistance: >50% of older patients do not respond to current antidepressants. Therefore, new effective interventions for prevention and treatment of depression in older individuals need to be developed, which requires a better understanding of the mechanisms underlying depression. The pathophysiology of depression is multifactorial and complex. Microvascular dysfunction may be an early and targetable mechanism in the development of depression, notably depression that initiates in late life (late-onset depression). Late-onset depression commonly co-occurs with other diseases or syndromes that may share a microvascular origin, including apathy, cognitive impairment, dementia, and stroke. Together, these disabilities may all be part of one large phenotype resulting from global cerebral microvascular dysfunction. In this review, we discuss the pathophysiology of microvascular dysfunction-related late-onset depression, summarize recent epidemiological evidence on the association between cerebral microvascular dysfunction and depression, and indicate potential drivers of cerebral microvascular dysfunction. We also propose the hypothesis that depression may be a manifestation of a larger phenotype of cerebral microvascular dysfunction, highlight potential therapeutic targets and interventions, and give directions for future research.
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Affiliation(s)
- Jean-Philippe Empana
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France
| | - Pierre Boutouyrie
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France
| | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France
| | - Xavier Jouven
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France
| | - Thomas T van Sloten
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center, Paris, France; School for Cardiovascular Diseases Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
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Boulestreau R, Lucas L, Cremer A, Debeugny S, Rubin S, Gaudissard J, Doublet J, Sibon I, Gosse P. Neurologically asymptomatic patients frequently present cerebral injuries during malignant hypertension: a MRI study. J Hypertens 2021. [PMID: 34343146 DOI: 10.1097/HJH.0000000000002950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute and diffuse microvascular damage characterizes malignant hypertension (MHT), the deadliest form of hypertension (HTN). Although its ophthalmological, renal and cardiological repercussions are well known, brain involvement is considered rare with few descriptions, although it is one of the main causes of death. We hypothesized that brain MRI abnormalities are common in MHT, even in patients without objective neurological signs. METHOD We analyzed retrospectively the brain MRI of patients admitted for acute MHT between 2008 and 2018 in Bordeaux University Hospital, regardless of their neurological status. A trained operator analyzed every brain MRI, looking for posterior reversible encephalopathy syndrome (PRES), ischemic stroke, intracerebral hematoma (ICH) and microangiopathy markers. We included 58 patients without neurological signs, 66% were men, and mean age was 45.6 ± 11.3 years. RESULTS Brain MRI were normal in 26% of patients but we found at least one acute abnormality on brain MRI in 29% and an Small Vessel Disease score (SVD score) of two or higher in 52%. In patients with neurological signs, these findings were 9, 53 and 70%, respectively. A PRES was found in 16% of asymptomatic patients and 31% had an ischemic stroke and/or a cerebral hematoma. CONCLUSION PRES, recent hematoma, ischemic stroke and severe cerebral microangiopathy are common findings in MHT patients without neurological signs on admission. The impact of these findings on patient management, and their cerebrovascular and cognitive prognostic value, should be established. Brain MRI might need to become systematic in patients suffering from MHT episodes.
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Jiménez-Balado J, Pizarro J, Riba-Llena I, Penalba A, Faura J, Palà E, Montaner J, Hernández-Guillamon M, Delgado P. New candidate blood biomarkers potentially associated with white matter hyperintensities progression. Sci Rep 2021; 11:14324. [PMID: 34253757 PMCID: PMC8275657 DOI: 10.1038/s41598-021-93498-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022] Open
Abstract
We aimed to discover blood biomarkers associated with longitudinal changes in white matter hyperintensities (WMH). This study was divided into a discovery phase and a replication phase. Subjects in both studies were patients with hypertension, aged 50-70, who underwent two magnetic resonance imaging (MRI) sessions and blood extractions over a 4-year follow-up period. In the discovery phase, we screened 1305 proteins in 12 subjects with WMH progression and in 12 matched control subjects. We found that 41 proteins were differentially expressed: 13 were upregulated and 28 were downregulated. We subsequently selected three biomarkers for replication in baseline and follow-up samples in 80 subjects with WMH progression and in 80 control subjects. The selected protein candidates for the replication were MMP9 (matrix metalloproteinase-9), which was higher in cases, MET (hepatocyte growth factor receptor) and ASAH2 (neutral ceramidase), which were both lower in cases of WMH progression. Baseline biomarker concentrations did not predict WMH progression. In contrast, patients with WMH progression presented a steeper decline in MET over time. Furthermore, cases showed higher MMP9 and lower ASAH2 levels than controls at the follow-up. These results indicate that MMP9, MET, and ASAH2 are potentially associated with the progression of WMH, and could therefore be interesting candidates to validate in future studies.
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Affiliation(s)
- Joan Jiménez-Balado
- Neurovascular Research Lab. Vall D'Hebron Research Institute, Universitat Autònoma de Barcelona, Edifici Mediterrània, Planta 1ª, Laboratori 123, Passeig Vall d'Hebron 119-129, 08035, Barcelona, CP, Spain
| | - Jesús Pizarro
- Neurovascular Research Lab. Vall D'Hebron Research Institute, Universitat Autònoma de Barcelona, Edifici Mediterrània, Planta 1ª, Laboratori 123, Passeig Vall d'Hebron 119-129, 08035, Barcelona, CP, Spain
| | - Iolanda Riba-Llena
- Neurovascular Research Lab. Vall D'Hebron Research Institute, Universitat Autònoma de Barcelona, Edifici Mediterrània, Planta 1ª, Laboratori 123, Passeig Vall d'Hebron 119-129, 08035, Barcelona, CP, Spain
| | - Anna Penalba
- Neurovascular Research Lab. Vall D'Hebron Research Institute, Universitat Autònoma de Barcelona, Edifici Mediterrània, Planta 1ª, Laboratori 123, Passeig Vall d'Hebron 119-129, 08035, Barcelona, CP, Spain
| | - Júlia Faura
- Neurovascular Research Lab. Vall D'Hebron Research Institute, Universitat Autònoma de Barcelona, Edifici Mediterrània, Planta 1ª, Laboratori 123, Passeig Vall d'Hebron 119-129, 08035, Barcelona, CP, Spain
| | - Elena Palà
- Neurovascular Research Lab. Vall D'Hebron Research Institute, Universitat Autònoma de Barcelona, Edifici Mediterrània, Planta 1ª, Laboratori 123, Passeig Vall d'Hebron 119-129, 08035, Barcelona, CP, Spain
| | - Joan Montaner
- Neurovascular Research Lab. Vall D'Hebron Research Institute, Universitat Autònoma de Barcelona, Edifici Mediterrània, Planta 1ª, Laboratori 123, Passeig Vall d'Hebron 119-129, 08035, Barcelona, CP, Spain.,Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Mar Hernández-Guillamon
- Neurovascular Research Lab. Vall D'Hebron Research Institute, Universitat Autònoma de Barcelona, Edifici Mediterrània, Planta 1ª, Laboratori 123, Passeig Vall d'Hebron 119-129, 08035, Barcelona, CP, Spain
| | - Pilar Delgado
- Neurovascular Research Lab. Vall D'Hebron Research Institute, Universitat Autònoma de Barcelona, Edifici Mediterrània, Planta 1ª, Laboratori 123, Passeig Vall d'Hebron 119-129, 08035, Barcelona, CP, Spain. .,Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Dementia Unit, Neurology Service, Barcelona, Spain.
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20
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Weber RZ, Perron P, Rust R. Astrocytes for brain repair: More than just a neuron's sidekick. Brain Pathol 2021; 31:e12999. [PMID: 34196052 PMCID: PMC8412072 DOI: 10.1111/bpa.12999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 12/18/2022] Open
Abstract
Transplantation of glial enriched progenitors provides therapeutic effects on axonal damage, cognitive and motor function following white matter stroke.
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Affiliation(s)
- Rebecca Z Weber
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Patrick Perron
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Ruslan Rust
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
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21
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Zee B, Wong Y, Lee J, Fan Y, Zeng J, Lam B, Wong A, Shi L, Lee A, Kwok C, Lai M, Mok V, Lau A. Machine-learning method for localization of cerebral white matter hyperintensities in healthy adults based on retinal images. Brain Commun 2021; 3:fcab124. [PMID: 34222872 PMCID: PMC8249101 DOI: 10.1093/braincomms/fcab124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/26/2021] [Accepted: 04/14/2021] [Indexed: 11/12/2022] Open
Abstract
Retinal vessels are known to be associated with various cardiovascular and cerebrovascular disease outcomes. Recent research has shown significant correlations between retinal characteristics and the presence of cerebral small vessel disease as measured by white matter hyperintensities from cerebral magnetic resonance imaging. Early detection of age-related white matter changes using retinal images is potentially helpful for population screening and allow early behavioural and lifestyle intervention. This study investigates the ability of the machine-learning method for the localization of brain white matter hyperintensities. All subjects were age 65 or above without any history of stroke and dementia and recruited from local community centres and community networks. Subjects with known retinal disease or disease influencing vessel structure in colour retina images were excluded. All subjects received MRI on the brain, and age-related white matter changes grading was determined from MRI as the primary endpoint. The presence of age-related white matter changes on each of the six brain regions was also studied. Retinal images were captured using a fundus camera, and the analysis was done based on a machine-learning approach. A total of 240 subjects are included in the study. The analysis of various brain regions included the left and right sides of frontal lobes, parietal–occipital lobes and basal ganglia. Our results suggested that data from both eyes are essential for detecting age-related white matter changes in the brain regions, but the retinal parameters useful for estimation of the probability of age-related white matter changes in each of the brain regions may differ for different locations. Using a classification and regression tree approach, we also found that at least three significant heterogeneous subgroups of subjects were identified to be essential for the localization of age-related white matter changes. Namely those with age-related white matter changes in the right frontal lobe, those without age-related white matter changes in the right frontal lobe but with age-related white matter changes in the left parietal–occipital lobe, and the rest of the subjects. Outcomes such as risks of severe grading of age-related white matter changes and the proportion of hypertension were significantly related to these subgroups. Our study showed that automatic retinal image analysis is a convenient and non-invasive screening tool for detecting age-related white matter changes and cerebral small vessel disease with good overall performance. The localization analysis for various brain regions shows that the classification models on each of the six brain regions can be done, and it opens up potential future clinical application.
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Affiliation(s)
- Benny Zee
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Clinical Trials and Biostatistics Lab, CUHK Shenzhen Research Institute, Shenzhen, China
| | - Yanny Wong
- Margaret KL Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia and Gerald Choa Neuroscience Centre, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jack Lee
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Clinical Trials and Biostatistics Lab, CUHK Shenzhen Research Institute, Shenzhen, China
| | - Yuhua Fan
- Department of Neurology, First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.,Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department, National Key Discipline, Guangzhou 510080, China
| | - Jinsheng Zeng
- Department of Neurology, First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China.,Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department, National Key Discipline, Guangzhou 510080, China
| | - Bonnie Lam
- Margaret KL Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia and Gerald Choa Neuroscience Centre, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Adrian Wong
- Margaret KL Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia and Gerald Choa Neuroscience Centre, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Lin Shi
- BrainNow Research Institute, Shenzhen, Guangdong Province, China.,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Allen Lee
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Chloe Kwok
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Maria Lai
- Centre for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Vincent Mok
- Margaret KL Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia and Gerald Choa Neuroscience Centre, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Alexander Lau
- Margaret KL Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia and Gerald Choa Neuroscience Centre, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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22
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Humphreys CA, Smith C, Wardlaw JM. Correlations in post-mortem imaging-histopathology studies of sporadic human cerebral small vessel disease: A systematic review. Neuropathol Appl Neurobiol 2021; 47:910-930. [PMID: 34037264 DOI: 10.1111/nan.12737] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/07/2020] [Revised: 03/29/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
AIMS Sporadic human cerebral small vessel disease (SVD) commonly causes stroke and dementia but its pathogenesis is poorly understood. There are recognised neuroimaging and histopathological features. However, relatively few studies have examined the relationship between the radiological and pathological correlates of SVD; better correlation would promote greater insight into the underlying biological changes. METHODS We performed a systematic review to collate and appraise the information derived from studies that correlated histological with neuroimaging-defined SVD lesions. We searched for studies describing post-mortem imaging and histological tissue examination in adults, extracted data from published studies, categorised the information and compiled this narrative. RESULTS We identified 38 relevant studies, including at least 1146 subjects, 342 of these with SVD: 29 studies focussed on neuroradiological white matter lesions (WML), six on microinfarcts and three on dilated perivascular spaces (PVS) and lacunes. The histopathology terminology was diverse with few robust definitions. Reporting and methodology varied widely between studies, precluding formal meta-analysis. PVS and 'oedema' were frequent findings in WML, being described in at least 94 and 18 radiological WML, respectively, in addition to myelin pallor. Histopathological changes extended beyond the radiological lesion margins in at least 33 radiological WML. At least 43 radiological lesions not seen pathologically and at least 178 histological lesions were not identified on imaging. CONCLUSIONS Histopathological assessment of human SVD is hindered by inconsistent methodological approaches and unstandardised definitions. The data from this systematic review will help to develop standardised definitions to promote consistency in human SVD research.
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Affiliation(s)
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute at The University of Edinburgh, Edinburgh, UK.,Row Fogo Centre for Research into Ageing and the Brain, Edinburgh, UK
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23
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Jiang S, Wu S, Zhang S, Wu B. Advances in Understanding the Pathogenesis of Lacunar Stroke: From Pathology and Pathophysiology to Neuroimaging. Cerebrovasc Dis 2021; 50:588-596. [PMID: 33957622 DOI: 10.1159/000516052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/11/2020] [Accepted: 03/22/2021] [Indexed: 02/05/2023] Open
Abstract
Lacunar stroke (LS) accounts for about one-quarter of all acute ischemic strokes, represents an important marker of cerebral small vessel disease (CSVD), and has prognostic significance in terms of recurrent vascular events and vascular cognitive impairment. Our understanding of the etiology and pathogenesis of LS is largely based on the meticulous postmortem work of C. Miller Fisher in the late 1960s, with scarce subsequent pathological analysis of the "lacunar hypothesis" and no reliable approaches for direct in vivo imaging of the small intracranial vessels. The recent development of high-resolution MRI, which allows both large-vessel wall and perforating arteries to be imaged in one setting, provides the opportunity to advance understandings of the clinical mechanisms, imaging characteristics, and pathogenesis of LS. Given accumulating evidence of endothelial dysfunction and blood-brain-barrier disruption as early features of CSVD-related LS, advanced imaging may allow various underlying pathogenetic mechanisms to be defined and for better targeting of therapeutic approaches in LS. In this review, progress in understanding the pathogenesis of LS is outlined, covering pathology, pathophysiology, and imaging characteristics, with a focus toward future directions in the complex entity of LS.
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Affiliation(s)
- Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.,Department of Neurology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuting Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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24
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Llorente IL, Xie Y, Mazzitelli JA, Hatanaka EA, Cinkornpumin J, Miller DR, Lin Y, Lowry WE, Carmichael ST. Patient-derived glial enriched progenitors repair functional deficits due to white matter stroke and vascular dementia in rodents. Sci Transl Med 2021; 13:13/590/eaaz6747. [PMID: 33883275 DOI: 10.1126/scitranslmed.aaz6747] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/05/2020] [Accepted: 01/16/2021] [Indexed: 01/24/2023]
Abstract
Subcortical white matter stroke (WMS) accounts for up to 30% of all stroke events. WMS damages primarily astrocytes, axons, oligodendrocytes, and myelin. We hypothesized that a therapeutic intervention targeting astrocytes would be ideally suited for brain repair after WMS. We characterize the cellular properties and in vivo tissue repair activity of glial enriched progenitor (GEP) cells differentiated from human-induced pluripotent stem cells, termed hiPSC-derived GEPs (hiPSC-GEPs). hiPSC-GEPs are derived from hiPSC-neural progenitor cells via an experimental manipulation of hypoxia inducible factor activity by brief treatment with a prolyl hydroxylase inhibitor, deferoxamine. This treatment permanently biases these cells to further differentiate toward an astrocyte fate. hiPSC-GEPs transplanted into the brain in the subacute period after WMS in mice migrated widely, matured into astrocytes with a prorepair phenotype, induced endogenous oligodendrocyte precursor proliferation and remyelination, and promoted axonal sprouting. hiPSC-GEPs enhanced motor and cognitive recovery compared to other hiPSC-differentiated cell types. This approach establishes an hiPSC-derived product with easy scale-up capabilities that might be effective for treating WMS.
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Affiliation(s)
- Irene L Llorente
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Yuan Xie
- Department of Biochemistry and Molecular Biology, University of Chicago, Chicago, IL 60637, USA
| | - Jose A Mazzitelli
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Emily A Hatanaka
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.,Department of Molecular, Cell and Developmental Biology, UCLA, Los Angeles, CA 90095, USA
| | - Jessica Cinkornpumin
- Department of Molecular, Cell and Developmental Biology, UCLA, Los Angeles, CA 90095, USA
| | - David R Miller
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Ying Lin
- Department of Molecular, Cell and Developmental Biology, UCLA, Los Angeles, CA 90095, USA
| | - William E Lowry
- Department of Molecular, Cell and Developmental Biology, UCLA, Los Angeles, CA 90095, USA.
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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25
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Moretti R, Giuffré M, Caruso P, Gazzin S, Tiribelli C. Homocysteine in Neurology: A Possible Contributing Factor to Small Vessel Disease. Int J Mol Sci 2021; 22:ijms22042051. [PMID: 33669577 PMCID: PMC7922986 DOI: 10.3390/ijms22042051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022] Open
Abstract
Homocysteine (Hcy) is a sulfur-containing amino acid generated during methionine metabolism, accumulation of which may be caused by genetic defects or the deficit of vitamin B12 and folate. A serum level greater than 15 micro-mols/L is defined as hyperhomocysteinemia (HHcy). Hcy has many roles, the most important being the active participation in the transmethylation reactions, fundamental for the brain. Many studies focused on the role of homocysteine accumulation in vascular or degenerative neurological diseases, but the results are still undefined. More is known in cardiovascular disease. HHcy is a determinant for the development and progression of inflammation, atherosclerotic plaque formation, endothelium, arteriolar damage, smooth muscle cell proliferation, and altered-oxidative stress response. Conversely, few studies focused on the relationship between HHcy and small vessel disease (SVD), despite the evidence that mice with HHcy showed a significant end-feet disruption of astrocytes with a diffuse SVD. A severe reduction of vascular aquaporin-4-water channels, lower levels of high-functioning potassium channels, and higher metalloproteinases are also observed. HHcy modulates the N-homocysteinylation process, promoting a pro-coagulative state and damage of the cellular protein integrity. This altered process could be directly involved in the altered endothelium activation, typical of SVD and protein quality, inhibiting the ubiquitin-proteasome system control. HHcy also promotes a constant enhancement of microglia activation, inducing the sustained pro-inflammatory status observed in SVD. This review article addresses the possible role of HHcy in small-vessel disease and understands its pathogenic impact.
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Affiliation(s)
- Rita Moretti
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.G.); (P.C.)
- Correspondence:
| | - Mauro Giuffré
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.G.); (P.C.)
| | - Paola Caruso
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.G.); (P.C.)
| | - Silvia Gazzin
- Italian Liver Foundation, AREA SCIENCE PARK, 34149 Trieste, Italy; (S.G.); (C.T.)
| | - Claudio Tiribelli
- Italian Liver Foundation, AREA SCIENCE PARK, 34149 Trieste, Italy; (S.G.); (C.T.)
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26
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Chen X, Wang L, Jiang J, Gao Y, Zhang R, Zhao X, Shen T, Dai Q, Li J. Association of neuroimaging markers of cerebral small vessel disease with short-term outcomes in patients with minor cerebrovascular events. BMC Neurol 2021; 21:21. [PMID: 33441129 PMCID: PMC7805057 DOI: 10.1186/s12883-021-02043-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background Increasing evidences have showed that neuroimaging markers of SVD can predict the short-term outcome of acute ischemic stroke (AIS). It is unclear that whether neuroimaging markers of SVD are also associated with short-term outcomes of minor cerebrovascular events. In the present study, we investigate neuroimaging markers of SVD in order to explore their roles in prediction of short-term outcome in patients with minor cerebrovascular events. Methods Consecutive first-ever stroke patients (n = 546) from the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. A total of 388 patients were enrolled according to minor cerebrovascular events definition (National Institutes of Health Stroke Scale Score ≤ 3) and exclusion criteria. MRI scans were performed within 7 days of stroke onset, and then neuroimaging markers of SVD including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS), SVD burden scores were assessed. We completed baseline characteristics and evaluated the relationships of short-term outcomes to SVD neuroimaging markers and SVD scores. The 90-day modified Rankin Scale (mRS) was thought as primary outcome and was dichotomized as good functional outcome (mRS 0–1) and poor outcome (mRS 2–6). Secondary outcomes were stroke progression and stroke recurrence. Results Higher age, National Institutes of Health Stroke Scale (NIHSS) upon admission, lipoprotein-associated phospholipase A2 (LP-PLA2) and lacunes, Fazekas score were correlated with poor functional outcome (P < 0.05), But after adjusting for confounding variables, among the neuroimaging markers of cerebral small vessel disease, only Fazekas score (OR, 1.343; 95% confidence interval, 1.020–1.770; P = 0.036) was found to be associated with poor outcome at 90 days. Higher Fazekas and SVD scores were not associated with stroke progression or stroke recurrence. Conclusion WMH can predict the poor functional outcome of minor cerebrovascular events. Adding other neuroimaging markers of SVD and total SVD burden score, however, does not improve the prediction, which indicated WMH can as neuroimaging markers for guiding the treatment of minor cerebrovascular events.
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Affiliation(s)
- Xuemei Chen
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China.
| | - Lin Wang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Junying Jiang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Yuanyuan Gao
- Department of General Practice, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Rui Zhang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Xiaoyuan Zhao
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Tingwen Shen
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Qi Dai
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China.
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27
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Zhao L, Lee A, Fan YH, Mok VCT, Shi L. Magnetic resonance imaging manifestations of cerebral small vessel disease: automated quantification and clinical application. Chin Med J (Engl) 2020; 134:151-60. [PMID: 33443936 DOI: 10.1097/CM9.0000000000001299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The common cerebral small vessel disease (CSVD) neuroimaging features visible on conventional structural magnetic resonance imaging include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. The CSVD neuroimaging features have shared and distinct clinical consequences, and the automatic quantification methods for these features are increasingly used in research and clinical settings. This review article explores the recent progress in CSVD neuroimaging feature quantification and provides an overview of the clinical consequences of these CSVD features as well as the possibilities of using these features as endpoints in clinical trials. The added value of CSVD neuroimaging quantification is also discussed for researches focused on the mechanism of CSVD and the prognosis in subjects with CSVD.
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28
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Moretti R, Caruso P. An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy. Int J Mol Sci 2020; 21:E6506. [PMID: 32899565 DOI: 10.3390/ijms21186506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/21/2022] Open
Abstract
We studied 114 primitive cerebral neoplasia, that were surgically treated, and underwent radiotherapy (RT), and compared their results to those obtained by 190 patients diagnosed with subcortical vascular dementia (sVAD). Patients with any form of primitive cerebral neoplasia underwent whole-brain radiotherapy. All the tumor patients had regional field partial brain RT, which encompassed each tumor, with an average margin of 2.6 cm from the initial target tumor volume. We observed in our patients who have been exposed to a higher dose of RT (30–65 Gy) a cognitive and behavior decline similar to that observed in sVAD, with the frontal dysexecutive syndrome, apathy, and gait alterations, but with a more rapid onset and with an overwhelming effect. Multiple mechanisms are likely to be involved in radiation-induced cognitive impairment. The active site of RT brain damage is the white matter areas, particularly the internal capsule, basal ganglia, caudate, hippocampus, and subventricular zone. In all cases, radiation damage inside the brain mainly focuses on the cortical–subcortical frontal loops, which integrate and process the flow of information from the cortical areas, where executive functions are “elaborated” and prepared, towards the thalamus, subthalamus, and cerebellum, where they are continuously refined and executed. The active mechanisms that RT drives are similar to those observed in cerebral small vessel disease (SVD), leading to sVAD. The RT’s primary targets, outside the tumor mass, are the blood–brain barrier (BBB), the small vessels, and putative mechanisms that can be taken into account are oxidative stress and neuro-inflammation, strongly associated with the alteration of NMDA receptor subunit composition.
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Elliott ML. MRI-based biomarkers of accelerated aging and dementia risk in midlife: how close are we? Ageing Res Rev 2020; 61:101075. [PMID: 32325150 DOI: 10.1016/j.arr.2020.101075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/04/2019] [Revised: 03/10/2020] [Accepted: 04/15/2020] [Indexed: 01/18/2023]
Abstract
The global population is aging, leading to an increasing burden of age-related neurodegenerative disease. Efforts to intervene against age-related dementias in older adults have generally proven ineffective. These failures suggest that a lifetime of brain aging may be difficult to reverse once widespread deterioration has occurred. To test interventions in younger populations, biomarkers of brain aging are needed that index subtle signs of accelerated brain deterioration that are part of the putative pathway to dementia. Here I review potential MRI-based biomarkers that could connect midlife brain aging to later life dementia. I survey the literature with three questions in mind, 1) Does the biomarker index age-related changes across the lifespan? 2) Does the biomarker index cognitive ability and cognitive decline? 3) Is the biomarker sensitive to known risk factors for dementia? I find that while there is preliminary support for some midlife MRI-based biomarkers for accelerated aging, the longitudinal research that would best answer these questions is still in its infancy and needs to be further developed. I conclude with suggestions for future research.
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Affiliation(s)
- Maxwell L Elliott
- Department of Psychology and Neuroscience, Duke University, 2020 West Main Street, Suite 030, Durham, NC, 27701, USA.
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30
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Rachmadi MF, Valdés-Hernández MDC, Makin S, Wardlaw J, Komura T. Automatic spatial estimation of white matter hyperintensities evolution in brain MRI using disease evolution predictor deep neural networks. Med Image Anal 2020; 63:101712. [PMID: 32428823 PMCID: PMC7294240 DOI: 10.1016/j.media.2020.101712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/10/2020] [Accepted: 04/20/2020] [Indexed: 11/24/2022]
Abstract
Previous studies have indicated that white matter hyperintensities (WMH), the main radiological feature of small vessel disease, may evolve (i.e., shrink, grow) or stay stable over a period of time. Predicting these changes are challenging because it involves some unknown clinical risk factors that leads to a non-deterministic prediction task. In this study, we propose a deep learning model to predict the evolution of WMH from baseline to follow-up (i.e., 1-year later), namely "Disease Evolution Predictor" (DEP) model, which can be adjusted to become a non-deterministic model. The DEP model receives a baseline image as input and produces a map called "Disease Evolution Map" (DEM), which represents the evolution of WMH from baseline to follow-up. Two DEP models are proposed, namely DEP-UResNet and DEP-GAN, which are representatives of the supervised (i.e., need expert-generated manual labels to generate the output) and unsupervised (i.e., do not require manual labels produced by experts) deep learning algorithms respectively. To simulate the non-deterministic and unknown parameters involved in WMH evolution, we modulate a Gaussian noise array to the DEP model as auxiliary input. This forces the DEP model to imitate a wider spectrum of alternatives in the prediction results. The alternatives of using other types of auxiliary input instead, such as baseline WMH and stroke lesion loads are also proposed and tested. Based on our experiments, the fully supervised machine learning scheme DEP-UResNet regularly performed better than the DEP-GAN which works in principle without using any expert-generated label (i.e., unsupervised). However, a semi-supervised DEP-GAN model, which uses probability maps produced by a supervised segmentation method in the learning process, yielded similar performances to the DEP-UResNet and performed best in the clinical evaluation. Furthermore, an ablation study showed that an auxiliary input, especially the Gaussian noise, improved the performance of DEP models compared to DEP models that lacked the auxiliary input regardless of the model's architecture. To the best of our knowledge, this is the first extensive study on modelling WMH evolution using deep learning algorithms, which deals with the non-deterministic nature of WMH evolution.
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Affiliation(s)
- Muhammad Febrian Rachmadi
- School of Informatics, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | | | - Stephen Makin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Centre for Rural Health, University of Aberdeen, UK
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Taku Komura
- School of Informatics, University of Edinburgh, Edinburgh, UK
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Abstract
Lacunes on magnetic resonance imaging (MRI) are considered as a key hallmark for evaluating the progression and severity of cerebral small vessel diseases. We aimed to review the MRI diagnostic criteria, frequency, predictors and clinical impact of incident lacunes in the largest longitudinal studies. Analyses were restricted to cohort studies of more than 50 individuals that investigated incident lacunes over a duration of at least one year. We observed that: (1) MRI parameters and definition of lacunes are inconsistent across studies, (2) the frequency of incident lacunes is strongly related to the previous clinical and MRI status at individual level, (3) both age and hypertension diagnosed at onset predict incident lacunes but the exact impact of blood pressure level during follow-up remains undetermined, (4) the clinical correlates of these lesions on cognition are repeatedly observed but the exact consequences on motor or gait performances are not always evaluated. Homogenization of imaging techniques, the use of strict diagnostic criteria and a broader clinical assessment considering motor and gait performances should be recommended in future longitudinal studies of incident lacunes including clinical trials testing preventative treatments in cerebral small vessel diseases.
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Affiliation(s)
- Yifeng Ling
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hugues Chabriat
- Department of Neurology, Groupe Hospitalier Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris (APHP), Université Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité (INSERM U1161), Paris, France
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32
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Zhao C, Liang Y, Chen T, Zhong Y, Li X, Wei J, Li C, Zhang X. Prediction of cognitive performance in old age from spatial probability maps of white matter lesions. Aging (Albany NY) 2020; 12:4822-4835. [PMID: 32191226 PMCID: PMC7138592 DOI: 10.18632/aging.102901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/05/2020] [Indexed: 01/18/2023]
Abstract
The purposes of this study were to explore the association between cognitive performance and white matter lesions (WMLs), and to investigate whether it is possible to predict cognitive impairment using spatial maps of WMLs. These WML maps were produced for 263 elders from the OASIS-3 dataset, and a relevance vector regression (RVR) model was applied to predict neuropsychological performance based on the maps. The association between the spatial distribution of WMLs and cognitive function was examined using diffusion tensor imaging data. WML burden significantly associated with increasing age (r=0.318, p<0.001) and cognitive decline. Eight of 15 neuropsychological measures could be accurately predicted, and the mini-mental state examination (MMSE) test achieved the highest predictive accuracy (CORR=0.28, p<0.003). WMLs located in bilateral tapetum, posterior corona radiata, and thalamic radiation contributed the most prediction power. Diffusion indexes in these regions associated significantly with cognitive performance (axial diffusivity>radial diffusivity>mean diffusivity>fractional anisotropy). These results show that the combination of the extent and location of WMLs exhibit great potential to serve as a generalizable marker of multidomain neurocognitive decline in the aging population. The results may also shed light on the mechanism underlying white matter changes during the progression of cognitive decline and aging.
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Affiliation(s)
- Cui Zhao
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Ying Liang
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Ting Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Yihua Zhong
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Xianglong Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Jing Wei
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Chunlin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Xu Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
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33
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Moretti R, Caruso P. Small Vessel Disease-Related Dementia: An Invalid Neurovascular Coupling? Int J Mol Sci 2020; 21:E1095. [PMID: 32046035 PMCID: PMC7036993 DOI: 10.3390/ijms21031095] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
The arteriosclerosis-dependent alteration of brain perfusion is one of the major determinants in small vessel disease, since small vessels have a pivotal role in the brain's autoregulation. Nevertheless, as far as we know, endothelium distress can potentiate the flow dysregulation and lead to subcortical vascular dementia that is related to small vessel disease (SVD), also being defined as subcortical vascular dementia (sVAD), as well as microglia activation, chronic hypoxia and hypoperfusion, vessel-tone dysregulation, altered astrocytes, and pericytes functioning blood-brain barrier disruption. The molecular basis of this pathology remains controversial. The apparent consequence (or a first event, too) is the macroscopic alteration of the neurovascular coupling. Here, we examined the possible mechanisms that lead a healthy aging process towards subcortical dementia. We remarked that SVD and white matter abnormalities related to age could be accelerated and potentiated by different vascular risk factors. Vascular function changes can be heavily influenced by genetic and epigenetic factors, which are, to the best of our knowledge, mostly unknown. Metabolic demands, active neurovascular coupling, correct glymphatic process, and adequate oxidative and inflammatory responses could be bulwarks in defense of the correct aging process; their impairments lead to a potentially catastrophic and non-reversible condition.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy;
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Abstract
Small vessel disease is a very common pathological process, which plays a key role in the development of stroke and cognitive impairment and, at the same time, affects other organs. The search for optimal drugs for prevention and treatment of small vessel disease has been continuing. The results of new studies enable further development of new treatment strategies. Currently, the drugs with neurotrophic properties become more and more important.
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Affiliation(s)
- M V Putilina
- Pirogov Russian National Research Medical Unversity, Moscow, Russia
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35
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Chen W, Park K, Pan Y, Koretsky AP, Du C. Interactions between stimuli-evoked cortical activity and spontaneous low frequency oscillations measured with neuronal calcium. Neuroimage 2020; 210:116554. [PMID: 31972283 DOI: 10.1016/j.neuroimage.2020.116554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/07/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
Spontaneous brain activity has been widely used to map brain connectivity. The interactions between task-evoked brain responses and the spontaneous cortical oscillations, especially within the low frequency range of ~0.1 Hz, are not fully understood. Trial-to-trial variabilities in brain's response to sensory stimuli and the ability for brain to detect under noisy conditions suggest an appreciable impact of the brain state. Using a multimodality imaging platform, we simultaneously imaged neuronal Ca2+ and cerebral hemodynamics at baseline and in response to single-pulse forepaw stimuli in rat's somatosensory cortex. The high sensitivity of this system enables detection of responses to very weak and strong stimuli and real time determination of low frequency oscillations without averaging. Results show that the ongoing neuronal oscillations inversely modulate Ca2+ transients evoked by sensory stimuli. High intensity stimuli reset the spontaneous neuronal oscillations to an unpreferable excitability following the stimulus. Cerebral hemodynamic responses also inversely interact with the spontaneous hemodynamic oscillations, correlating with the neuronal Ca2+ transient changes. The results reveal competing interactions between spontaneous oscillations and stimulation-evoked brain activities in somatosensory cortex and the resultant hemodynamics.
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Affiliation(s)
- Wei Chen
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Kicheon Park
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Yingtian Pan
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Alan P Koretsky
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Congwu Du
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794, USA.
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36
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Moretti R, Peinkhofer C. B Vitamins and Fatty Acids: What Do They Share with Small Vessel Disease-Related Dementia? Int J Mol Sci 2019; 20:E5797. [PMID: 31752183 PMCID: PMC6888477 DOI: 10.3390/ijms20225797] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/21/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
Many studies have been written on vitamin supplementation, fatty acid, and dementia, but results are still under debate, and no definite conclusion has yet been drawn. Nevertheless, a significant amount of lab evidence confirms that vitamins of the B group are tightly related to gene control for endothelium protection, act as antioxidants, play a co-enzymatic role in the most critical biochemical reactions inside the brain, and cooperate with many other elements, such as choline, for the synthesis of polyunsaturated phosphatidylcholine, through S-adenosyl-methionine (SAM) methyl donation. B-vitamins have anti-inflammatory properties and act in protective roles against neurodegenerative mechanisms, for example, through modulation of the glutamate currents and a reduction of the calcium currents. In addition, they also have extraordinary antioxidant properties. However, laboratory data are far from clinical practice. Many studies have tried to apply these results in everyday clinical activity, but results have been discouraging and far from a possible resolution of the associated mysteries, like those represented by Alzheimer's disease (AD) or small vessel disease dementia. Above all, two significant problems emerge from the research: No consensus exists on general diagnostic criteria-MCI or AD? Which diagnostic criteria should be applied for small vessel disease-related dementia? In addition, no general schema exists for determining a possible correct time of implementation to have effective results. Here we present an up-to-date review of the literature on such topics, shedding some light on the possible interaction of vitamins and phosphatidylcholine, and their role in brain metabolism and catabolism. Further studies should take into account all of these questions, with well-designed and world-homogeneous trials.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy;
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Abstract
Importance Stroke is the second leading cause of death in the world, and nearly one-third of ischemic strokes are lacunar strokes (LSs) or small subcortical infarcts. Although smaller in size, they create large problems, leaving many patients with intellectual and physical disabilities. Because there are limitations in understanding the underlying pathophysiology of LS, the development of novel therapies has been slow. Observations When the term lacune was described in the 1800s, its underlying pathophysiological basis was obscure. In the 1960s, C. Miller Fisher, MD, performed autopsy studies that showed that vessels supplying lacunes displayed segmental arteriolar disorganization, characterized by vessel enlargement, hemorrhage, and fibrinoid deposition. For these pathologic changes, he coined the term lipohyalinosis. Since that time, few attempts have been made to reconcile this pathologic description with modern mechanisms of cerebral small vessel disease (CSVD). During the past 6 years, progress has been made in understanding the clinical mechanisms, imaging characteristics, and genetic basis of LS. Conclusions and Relevance Questions persist regarding the order of events related to the initiation and progression of CSVD, how LS is related to other sequelae of CSVD, and whether LS is part of a systemic disease process. The relative roles of aging, oxidative stress, mechanical stress, genetic predisposition, and other vascular risk factors should be further studied, especially in the era of widespread antihypertensive use. Although understanding of endothelial dysfunction has increased, future work on the role of media and adventitial dysfunction should be explored. Recent advances in mapping the brain vasculome may generate new hypotheses. The investigation of new therapeutic targets, aimed at reversing CSVD processes and promoting neural repair after LS, depends upon further understanding these basic mechanisms.
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Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Eng H Lo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Louis R Caplan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Caruso P, Signori R, Moretti R. Small vessel disease to subcortical dementia: a dynamic model, which interfaces aging, cholinergic dysregulation and the neurovascular unit. Vasc Health Risk Manag 2019; 15:259-281. [PMID: 31496716 PMCID: PMC6689673 DOI: 10.2147/vhrm.s190470] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background Small vessels have the pivotal role for the brain’s autoregulation. The arteriosclerosis-dependent alteration of the brain perfusion is one of the major determinants in small vessel disease. Endothelium distress can potentiate the flow dysregulation and lead to subcortical vascular dementia (sVAD). sVAD increases morbidity and disability. Epidemiological studies have shown that sVAD shares with cerebrovascular disease most of the common risk factors. The molecular basis of this pathology remains controversial. Purpose To detect the possible mechanisms between small vessel disease and sVAD, giving a broad vision on the topic, including pathological aspects, clinical and laboratory findings, metabolic process and cholinergic dysfunction. Methods We searched MEDLINE using different search terms (“vascular dementia”, “subcortical vascular dementia”, “small vessel disease”, “cholinergic afferents”, etc). Publications were selected from the past 20 years. Searches were extended to Embase, Cochrane Library, and LILIACS databases. All searches were done from January 1, 1998 up to January 31, 2018. Results A total of 560 studies showed up, and appropriate studies were included. Associations between traditional vascular risk factors have been isolated. We remarked that SVD and white matter abnormalities are seen frequently with aging and also that vascular and endothelium changes are related with age; the changes can be accelerated by different vascular risk factors. Vascular function changes can be heavily influenced by genetic and epigenetic factors. Conclusion Small vessel disease and the related dementia are two pathologies that deserve attention for their relevance and impact in clinical practice. Hypertension might be a historical problem for SVD and SVAD, but low pressure might be even more dangerous; CBF regional selective decrease seems to be a critical factor for small vessel disease-related dementia. In those patients, endothelium damage is a super-imposed condition. Several issues are still debatable, and more research is needed.
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Affiliation(s)
- Paola Caruso
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
| | - Riccardo Signori
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
| | - Rita Moretti
- Department of Medical, Surgical and Health Sciences, Neurology Clinic, University of Trieste, Trieste, Italy
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Hansen MR, Okuda DT. Precision medicine for multiple sclerosis promotes preventative medicine. Ann N Y Acad Sci 2019; 1420:62-71. [PMID: 29878402 DOI: 10.1111/nyas.13846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/17/2018] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 12/19/2022]
Abstract
Multiple sclerosis (MS) is a chronic, lifelong disease, currently without a cure that is responsible for significant neurological injury in young adults. Precision medicine for MS aims to provide a more exacting and refined approach toward management by providing recommendations based on disease subtype, clinical status, existing radiological data, para-clinical data, and other biological markers. To achieve better outcomes, the three stages of care-diagnosis, treatment, and management-should be optimized. However, as the temporal profile of disease behavior is highly variable in MS, and unlike outcomes from other chronic conditions (i.e., hypertension, diabetes mellitus, etc.), should precision medicine for MS be one that focuses more on disease prevention and lifestyle modifications beyond recommendations for the use of disease-modifying therapies? As scientific advancements continue within the field of neuroimmunology, and until reliable biomarkers that predict disease outcomes are available, success may be better achieved by focusing on modifiable factors to reduce future disability.
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Affiliation(s)
- Madison R Hansen
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Clinical Center for Multiple Sclerosis, Dallas, Texas
| | - Darin T Okuda
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Clinical Center for Multiple Sclerosis, Dallas, Texas
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40
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Gyanwali B, Vrooman H, Venketasubramanian N, Wong TY, Cheng CY, Chen C, Hilal S. Cerebral Small Vessel Disease and Enlarged Perivascular Spaces-Data From Memory Clinic and Population-Based Settings. Front Neurol 2019; 10:669. [PMID: 31293506 PMCID: PMC6603207 DOI: 10.3389/fneur.2019.00669] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/07/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Enlarged perivascular spaces (ePVS) are common finding on magnetic resonance imaging (MRI) in elderly. ePVS are thought to be associated with cerebral small vessel disease (SVD) such as white matter hyperintensities (WMH), lacunes, and cerebral microbleeds (CMBs). However, the different location of SVD and its relationship to ePVS distribution requires further investigation. Objective: To study the association between location and severity of SVD with ePVS from memory clinic and population-based settings. Methods: This study includes patients from an ongoing memory clinic based case-control study and participants from the population-based: Epidemiology of Dementia in Singapore study (EDIS). All participants underwent a comprehensive standardized evaluation including physical, medical and neuropsychological assessment and a brain MRI. CMBs and lacune location were categorized into strictly lobar, strictly deep and mixed, and ePVS location into centrum semiovale and basal ganglia. WMH volume was automatically segmented and was classified into anterior and posterior distribution. Negative binomial regression models were constructed to analyse associations between SVD and ePVS and the rate ratios (RR) and 95% confidence intervals (CI) were reported. Results: Of 375 patients (median age = 73 years) from memory clinic and 583 participants (median age = 70 years) from EDIS, the median total ePVS count was 17.0 and 7.0, respectively. Increased severity of SVD was not associated with total ePVS counts in both memory clinic and EDIS study. Analysis with the location of SVD and ePVS also showed similar results. However, in EDIS study, presence of ≥2 lacunes [RR = 1.61, 95% CI = 1.3, 2.30, p = 0.009], presence of ≥2 CMBs [RR = 1.40, 95% CI = 1.08, 1.83, p = 0.012], and higher volume of WMH [RR = 1.41, 95% CI = 1.10, 1.81, p = 0.006] were associated with basal ganglia ePVS independent of age, gender and vascular risk factors. Conclusion: In this study, we found that the ePVS were not associated with the location and severity of SVD in the memory-clinic patients. However, only severity of SVD was associated with basal ganglia ePVS in the population-based setting. Our findings will need to be studied further in different cohorts so as to understand the mechanism underlying different SVD types in subclinical and clinical phases as well as for predicting cognitive decline.
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Affiliation(s)
- Bibek Gyanwali
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore.,Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Henri Vrooman
- Departments of Radiology and Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Tien Yin Wong
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore.,Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Saima Hilal
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore.,Department of Pharmacology, National University of Singapore, Singapore, Singapore.,Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
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41
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Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications. Lancet Neurol 2019; 18:684-696. [DOI: 10.1016/s1474-4422(19)30079-1] [Citation(s) in RCA: 500] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 02/06/2023]
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42
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Regenhardt RW, Das AS, Ohtomo R, Lo EH, Ayata C, Gurol ME. Pathophysiology of Lacunar Stroke: History's Mysteries and Modern Interpretations. J Stroke Cerebrovasc Dis 2019; 28:2079-2097. [PMID: 31151839 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 01/23/2019] [Revised: 04/13/2019] [Accepted: 05/04/2019] [Indexed: 01/13/2023] Open
Abstract
Since the term "lacune" was adopted in the 1800s to describe infarctions from cerebral small vessels, their underlying pathophysiological basis remained obscure until the 1960s when Charles Miller Fisher performed several autopsy studies of stroke patients. He observed that the vessels displayed segmental arteriolar disorganization that was associated with vessel enlargement, hemorrhage, and fibrinoid deposition. He coined the term "lipohyalinosis" to describe the microvascular mechanism that engenders small subcortical infarcts in the absence of a compelling embolic source. Since Fisher's early descriptions of lipohyalinosis and lacunar stroke (LS), there have been many advancements in the understanding of this disease process. Herein, we review lipohyalinosis as it relates to modern concepts of cerebral small vessel disease (cSVD). We discuss clinical classifications of LS as well as radiographic definitions based on modern neuroimaging techniques. We provide a broad and comprehensive overview of LS pathophysiology both at the vessel and parenchymal levels. We also comment on the role of biomarkers, the possibility of systemic disease processes, and advancements in the genetics of cSVD. Lastly, we assess preclinical models that can aid in studying LS disease pathogenesis. Enhanced understanding of this highly prevalent disease will allow for the identification of novel therapeutic targets capable of mitigating disease sequelae.
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Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryo Ohtomo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eng H Lo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cenk Ayata
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mahmut Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Gyanwali B, Shaik MA, Tan BY, Venketasubramanian N, Chen C, Hilal S. Risk Factors for and Clinical Relevance of Incident and Progression of Cerebral Small Vessel Disease Markers in an Asian Memory Clinic Population. J Alzheimers Dis 2019; 67:1209-1219. [DOI: 10.3233/jad-180911] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bibek Gyanwali
- Memory Aging & Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, National University of Singapore, Singapore
| | - Muhammad Amin Shaik
- Memory Aging & Cognition Centre, National University Health System, Singapore
- Ageing Research Institute for Society and Education, Nanyang Technological University, Singapore
| | | | | | - Christopher Chen
- Memory Aging & Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, National University of Singapore, Singapore
| | - Saima Hilal
- Memory Aging & Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, National University of Singapore, Singapore
- Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Jiménez-Balado J, Riba-Llena I, Abril O, Garde E, Penalba A, Ostos E, Maisterra O, Montaner J, Noviembre M, Mundet X, Ventura O, Pizarro J, Delgado P. Cognitive Impact of Cerebral Small Vessel Disease Changes in Patients With Hypertension. Hypertension 2019; 73:342-349. [DOI: 10.1161/hypertensionaha.118.12090] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joan Jiménez-Balado
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Iolanda Riba-Llena
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Oscar Abril
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Edurne Garde
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Anna Penalba
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Elena Ostos
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Olga Maisterra
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Joan Montaner
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Maria Noviembre
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Xavier Mundet
- Primary Healthcare University Research Institute IDIAP Jordi Gol (X.M.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Oriol Ventura
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Jesus Pizarro
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
| | - Pilar Delgado
- From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.)
- Universitat Autònoma de Barcelona, Spain (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., X.M., O.V., J.P., P.D.)
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Forsberg KME, Zhang Y, Reiners J, Ander M, Niedermayer A, Fang L, Neugebauer H, Kassubek J, Katona I, Weis J, Ludolph AC, Del Tredici K, Braak H, Yilmazer-Hanke D. Endothelial damage, vascular bagging and remodeling of the microvascular bed in human microangiopathy with deep white matter lesions. Acta Neuropathol Commun 2018; 6:128. [PMID: 30470258 PMCID: PMC6260986 DOI: 10.1186/s40478-018-0632-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022] Open
Abstract
White matter lesions (WMLs) are a common manifestation of small vessel disease (SVD) in the elderly population. They are associated with an enhanced risk of developing gait abnormalities, poor executive function, dementia, and stroke with high mortality. Hypoperfusion and the resulting endothelial damage are thought to contribute to the development of WMLs. The focus of the present study was the analysis of the microvascular bed in SVD patients with deep WMLs (DWMLs) by using double- and triple-label immunohistochemistry and immunofluorescence. Simultaneous visualization of collagen IV (COLL4)-positive membranes and the endothelial glycocalyx in thick sections allowed us to identify endothelial recession in different types of string vessels, and two new forms of small vessel/capillary pathology, which we called vascular bagging and ghost string vessels. Vascular bags were pouches and tubes that were attached to vessel walls and were formed by multiple layers of COLL4-positive membranes. Vascular bagging was most severe in the DWMLs of cases with pure SVD (no additional vascular brain injury, VBI). Quantification of vascular bagging, string vessels, and the density/size of CD68-positive cells further showed widespread pathological changes in the frontoparietal and/or temporal white matter in SVD, including pure SVD and SVD with VBI, as well as a significant effect of the covariate age. Plasma protein leakage into vascular bags and the white matter parenchyma pointed to endothelial damage and basement membrane permeability. Hypertrophic IBA1-positive microglial cells and CD68-positive macrophages were found in white matter areas covered with networks of ghost vessels in SVD, suggesting phagocytosis of remnants of string vessels. However, the overall vessel density was not altered in our SVD cohort, which might result from continuous replacement of vessels. Our findings support the view that SVD is a progressive and generalized disease process, in which endothelial damage and vascular bagging drive remodeling of the microvasculature.
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Yee CH, Leung C, Wong YY, Lee S, Li J, Kwan P, Chu WC, Mok VC, Ng CF. Lower Urinary Tract Symptoms in Subjects with Subclinical Cerebral White Matter Lesions. J Aging Res 2018; 2018:1582092. [PMID: 30155303 DOI: 10.1155/2018/1582092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 01/15/2023] Open
Abstract
Aim We assessed the impact of cerebral white matter lesions (WMLs) on lower urinary tract symptoms in subjects with normal neurological and cognitive function. Methods A cohort of community-dwelling subjects aged ≥65 years were recruited to undergo MRI brain assessment. WMLs were graded using the Fazekas scale from 0 to 3. A separate telephone interview was carried out to assess the urinary symptoms in these subjects using the questionnaire Overactive Bladder-Validated 8-Question Awareness Tool (OAB-V8). Results 800 community-dwelling elderly subjects were recruited to undergo MRI brain. In this cohort, 431 subjects responded to the telephone interview concerning their urinary symptoms. Among the respondents, 21.1% did not exhibit any WML on their MRI brain. Most of the subjects (52.6%) exhibited grade 1 WML. On logistic regression, age was found to be positively correlated with the Fazekas score (correlation coefficient 0.203, p ≤ 0.01). Using a cutoff of 8 on OAB-V8, 22% of the respondents experienced OAB. Presence of WML, hypertension, or diabetes mellitus was not found to be correlated with storage urinary symptoms or OAB-V8 total score. Multiple logistic regression analysis did not show the presence of WML to be associated with the diagnosis of OAB (adjusted OR 1.13, 95% CI 0.65–1.96, p=0.659). Conclusions WML is associated with age and is common in the elderly population. Mild WML is subclinical, with no obvious neurological and urinary symptoms. Our cohort did not demonstrate a relationship between WML and lower urinary tract symptoms.
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Iordanova B, Vazquez A, Kozai TDY, Fukuda M, Kim SG. Optogenetic investigation of the variable neurovascular coupling along the interhemispheric circuits. J Cereb Blood Flow Metab 2018; 38:627-640. [PMID: 29372655 PMCID: PMC5888863 DOI: 10.1177/0271678x18755225] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022]
Abstract
The interhemispheric circuit connecting the left and the right mammalian brain plays a key role in integration of signals from the left and the right side of the body. The information transfer is carried out by modulation of simultaneous excitation and inhibition. Hemodynamic studies of this circuit are inconsistent since little is known about neurovascular coupling of mixed excitatory and inhibitory signals. We investigated the variability in hemodynamic responses driven by the interhemispheric circuit during optogenetic and somatosensory activation. We observed differences in the neurovascular response based on the stimulation site - cell bodies versus distal projections. In half of the experiments, optogenetic stimulation of the cell bodies evoked a predominant post-synaptic inhibition in the other hemisphere, accompanied by metabolic oxygen consumption without coupled functional hyperemia. When the same transcallosal stimulation resulted in predominant post-synaptic excitation, the hemodynamic response was biphasic, consisting of metabolic dip followed by functional hyperemia. Optogenetic suppression of the postsynaptic excitation abolished the coupled functional hyperemia. In contrast, light stimulation at distal projections evoked consistently a metabolic response. Our findings suggest that functional hyperemia requires signals originating from the cell body and the hemodynamic response variability appears to reflect the balance between the post-synaptic excitation and inhibition.
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Affiliation(s)
- Bistra Iordanova
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alberto Vazquez
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Takashi DY Kozai
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mitsuhiro Fukuda
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Korea
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Moon SY, de Souto Barreto P, Rolland Y, Chupin M, Bouyahia A, Fillon L, Mangin JF, Andrieu S, Cesari M, Vellas B. Prospective associations between white matter hyperintensities and lower extremity function. Neurology 2018. [DOI: 10.1212/wnl.0000000000005289] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
ObjectiveTo evaluate the relationship of white matter hyperintensities (WMH) with decline in lower extremity function (LEF) over approximately 3 years in dementia-free older adults with memory complaints.MethodsWe obtained brain MRI data from 458 community-dwelling adults, aged 70 years or over, at baseline, and from 358 adults over an average follow-up of 963 days. We evaluated LEF using the Short Physical Performance Battery (SPPB). We related baseline WMH volumes and progression to SPPB scores over time, using mixed-effect linear regressions. For the secondary analyses, we categorized baseline WMH volume into quartiles, and dichotomized the WMH progression to compare fast and slow progression.ResultsBaseline WMH volume (β = −0.017, 95% confidence interval [CI] −0.025 to −0.009), as well as WMH progression (β = −0.002, 95% CI −0.003 to −0.001), significantly associated with a decline in SPPB performance in adjusted analyses. Compared with the lowest quartile of baseline WMH volume, the highest quartile associated with a decline in SPPB performance (β = −0.301, 95% CI −0.558 to −0.044). Fast progression also associated with a decline in SPPB performance. We found clinically meaningful differences in the SPPB, with higher scores in participants with slow progression of WMH, at both 24 and 36 months.ConclusionsBaseline level and WMH progression associated with longitudinal decline in SPPB performance among older adults. We detected clinically meaningful differences in SPPB performance on comparing fast with slow progression of WMH, suggesting that speed of WMH progression is an important determinant of LEF during aging.
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Uiterwijk R, Staals J, Huijts M, de Leeuw PW, Kroon AA, van Oostenbrugge RJ. Framingham Stroke Risk Profile is related to cerebral small vessel disease progression and lower cognitive performance in patients with hypertension. J Clin Hypertens (Greenwich) 2018; 20:240-245. [PMID: 29357202 DOI: 10.1111/jch.13175] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 07/11/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022]
Abstract
The Framingham Stroke Risk Profile (FSRP) was developed to predict clinical stroke. We investigated if FSRP is associated with more "silent" effects of cerebrovascular disease, namely progression of cerebral small vessel disease (cSVD)-related brain damage and cognitive performance in hypertensive patients. Ninety patients with essential hypertension underwent a brain MRI scan and FSRP assessment at baseline, and a second brain MRI scan and neuropsychological assessment at 9-year follow-up. We visually rated progression of cSVD-related MRI markers. FSRP was associated with progressive periventricular white matter hyperintensities (P = .017) and new microbleeds (P = .031), but not after correction for the FSRP age component. FSRP was associated with lower overall cognitive performance (P < .001) and this remained significant after correction for the FSRP age component. A vascular risk score might be useful in predicting progression of cSVD-related brain damage or future cognitive performance in hypertensive patients. Age seems to be the most important component in FSRP.
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Affiliation(s)
- Renske Uiterwijk
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marjolein Huijts
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Abraham A Kroon
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Wang Y, Meng R, Song H, Liu G, Hua Y, Cui D, Zheng L, Feng W, Liebeskind DS, Fisher M, Ji X. Remote Ischemic Conditioning May Improve Outcomes of Patients With Cerebral Small-Vessel Disease. Stroke 2017; 48:3064-3072. [PMID: 29042490 DOI: 10.1161/strokeaha.117.017691] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [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: 04/13/2017] [Revised: 08/29/2017] [Accepted: 09/08/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the efficacy of remote ischemic conditioning (RIC) in patients with cerebral small-vessel disease. METHODS Thirty patients with cerebral small-vessel disease-related mild cognitive impairment were enrolled in this prospective, randomized controlled study for 1 year. Besides routine medical treatment, participants were randomized into the experimental group (n=14) undergoing 5 cycles consisting of ischemia followed by reperfusion for 5 minutes on both upper limbs twice daily for 1 year or the control group (n=16) who were treated with sham ischemia-reperfusion cycles. The primary outcome was the change of brain lesions, and secondary outcomes were changes of cognitive function, plasma biomarkers, and cerebral hemodynamic parameters both at baseline and at the end of 1-year follow-up. RESULTS Compared with pretreatment, the post-treatment white matter hyperintensities volume in the RIC group was significantly reduced (9.10±7.42 versus 6.46±6.05 cm3; P=0.020), whereas no significant difference was observed in the sham-RIC group (8.99±6.81 versus 8.07±6.56 cm3; P=0.085). The reduction of white matter hyperintensities volume in the RIC group was more substantial than that in sham group (-2.632 versus -0.935 cm3; P=0.049). No significant difference was found in the change of the number of lacunes between 2 groups (0 versus 0; P=0.694). A significant treatment difference at 1 year on visuospatial and executive ability was found between the 2 groups (0.639 versus 0.191; P=0.048). RIC showed greater effects compared with sham-RIC on plasma triglyceride (-0.433 versus 0.236 mmol/L; P=0.005), total cholesterol (-0.975 versus 0.134 mmol/L; P<0.001), low-density lipoprotein (-0.645 versus -0.029 mmol/L; P=0.034), and homocysteine (-4.737 versus -1.679 µmol/L; P=0.044). Changes of the pulsation indices of middle cerebral arteries from the baseline to 1 year were different between the 2 groups (right: -0.075 versus 0.043; P=0.030; left: -0.085 versus 0.043; P=0.010). CONCLUSIONS RIC seems to be potentially effective in patients with cerebral small-vessel disease in slowing cognition decline and reducing white matter hyperintensities. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01658306.
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Affiliation(s)
- Yuan Wang
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Ran Meng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Haiqing Song
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Gang Liu
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Yang Hua
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Dehua Cui
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Lemin Zheng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Wuwei Feng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - David S Liebeskind
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Marc Fisher
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Xunming Ji
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.).
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