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Rodriguez Lara F, Toro AR, Pinheiro A, Demissie S, Ekenze O, Martinez O, Parva P, Charidimou A, Ghosh S, DeCarli C, Seshadri S, Habes M, Maillard P, Romero JR. Relation of MRI-Visible Perivascular Spaces and Other MRI Markers of Cerebral Small Vessel Disease. Brain Sci 2023; 13:1323. [PMID: 37759924 PMCID: PMC10527297 DOI: 10.3390/brainsci13091323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Perivascular spaces (PVS) visible on brain MRI signal cerebral small vessel disease (CSVD). The coexistence of PVS with other CSVD manifestations likely increases the risk of adverse neurological outcomes. We related PVS to other CSVD manifestations and brain volumes that are markers of vascular brain injury and neurodegeneration. Framingham Heart Study (FHS) participants with CSVD ratings on brain MRI were included. PVS were rated in the basal ganglia (BG) and centrum semiovale (CSO) into grades I-IV and a category reflecting high burden in single or mixed CSO-BG regions. We related PVS to covert brain infarcts (CBI), white matter hyperintensities (WMH), cerebral microbleeds (CMB), total brain, hippocampal, and cortical gray matter volumes using adjusted multivariable regression analyses. In 2454 participants (mean age 54 ± 12 years), we observed that higher PVS burden in both BG and CSO was related to CMB in lobar and deep brain regions and increased WMH. Greater CSO PVS burden was associated with decreased total cortical gray volumes. PVS are associated with ischemic markers of CSVD and neurodegeneration markers. Further studies should elucidate the causality between PVS and other CSVD manifestations.
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Affiliation(s)
- Frances Rodriguez Lara
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA; (F.R.L.); (A.R.T.)
| | - Arturo Ruben Toro
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA; (F.R.L.); (A.R.T.)
| | - Adlin Pinheiro
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA 02118, USA; (A.P.); (S.D.)
- Framingham Heart Study, National Heart Lung and Blood Institute, Framingham, MA 01702, USA; (O.E.); (S.G.); (S.S.)
| | - Serkalem Demissie
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA 02118, USA; (A.P.); (S.D.)
- Framingham Heart Study, National Heart Lung and Blood Institute, Framingham, MA 01702, USA; (O.E.); (S.G.); (S.S.)
| | - Oluchi Ekenze
- Framingham Heart Study, National Heart Lung and Blood Institute, Framingham, MA 01702, USA; (O.E.); (S.G.); (S.S.)
- Graduate Medical Sciences, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Oliver Martinez
- Department of Neurology, University of California Davis, Davis, CA 95817, USA; (O.M.); (C.D.); (P.M.)
| | - Pedram Parva
- Department of Radiology, Veterans Affairs Boston Healthcare System, Boston, MA 02118, USA;
- Department of Radiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Andreas Charidimou
- Department of Neurology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA;
| | - Saptaparni Ghosh
- Framingham Heart Study, National Heart Lung and Blood Institute, Framingham, MA 01702, USA; (O.E.); (S.G.); (S.S.)
- Department of Neurology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA;
| | - Charles DeCarli
- Department of Neurology, University of California Davis, Davis, CA 95817, USA; (O.M.); (C.D.); (P.M.)
| | - Sudha Seshadri
- Framingham Heart Study, National Heart Lung and Blood Institute, Framingham, MA 01702, USA; (O.E.); (S.G.); (S.S.)
- Department of Neurology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA;
- The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX 78229, USA;
| | - Mohamad Habes
- The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX 78229, USA;
| | - Pauline Maillard
- Department of Neurology, University of California Davis, Davis, CA 95817, USA; (O.M.); (C.D.); (P.M.)
| | - Jose Rafael Romero
- Framingham Heart Study, National Heart Lung and Blood Institute, Framingham, MA 01702, USA; (O.E.); (S.G.); (S.S.)
- Department of Neurology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA;
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Okar SV, Hu F, Shinohara RT, Beck ES, Reich DS, Ineichen BV. The etiology and evolution of magnetic resonance imaging-visible perivascular spaces: Systematic review and meta-analysis. Front Neurosci 2023; 17:1038011. [PMID: 37065926 PMCID: PMC10098201 DOI: 10.3389/fnins.2023.1038011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesPerivascular spaces have been involved in neuroinflammatory and neurodegenerative diseases. Upon a certain size, these spaces can become visible on magnetic resonance imaging (MRI), referred to as enlarged perivascular spaces (EPVS) or MRI-visible perivascular spaces (MVPVS). However, the lack of systematic evidence on etiology and temporal dynamics of MVPVS hampers their diagnostic utility as MRI biomarker. Thus, the goal of this systematic review was to summarize potential etiologies and evolution of MVPVS.MethodsIn a comprehensive literature search, out of 1,488 unique publications, 140 records assessing etiopathogenesis and dynamics of MVPVS were eligible for a qualitative summary. 6 records were included in a meta-analysis to assess the association between MVPVS and brain atrophy.ResultsFour overarching and partly overlapping etiologies of MVPVS have been proposed: (1) Impairment of interstitial fluid circulation, (2) Spiral elongation of arteries, (3) Brain atrophy and/or perivascular myelin loss, and (4) Immune cell accumulation in the perivascular space. The meta-analysis in patients with neuroinflammatory diseases did not support an association between MVPVS and brain volume measures [R: −0.15 (95%-CI −0.40–0.11)]. Based on few and mostly small studies in tumefactive MVPVS and in vascular and neuroinflammatory diseases, temporal evolution of MVPVS is slow.ConclusionCollectively, this study provides high-grade evidence for MVPVS etiopathogenesis and temporal dynamics. Although several potential etiologies for MVPVS emergence have been proposed, they are only partially supported by data. Advanced MRI methods should be employed to further dissect etiopathogenesis and evolution of MVPVS. This can benefit their implementation as an imaging biomarker.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346564, identifier CRD42022346564.
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Affiliation(s)
- Serhat V. Okar
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Fengling Hu
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Erin S. Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Benjamin V. Ineichen
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Reproducible Science, University of Zurich, Zurich, Switzerland
- *Correspondence: Benjamin V. Ineichen, , ; orcid.org/0000-0003-1362-4819
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Silent brain infarcts, peripheral vascular disease and the risk of cardiovascular events in patients with hypertension. J Hypertens 2022; 40:1469-1477. [PMID: 35881448 DOI: 10.1097/hjh.0000000000003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS We aimed to study the relationship between cerebral small vessel disease (cSVD) lesions, as markers of subclinical target organ damage (TOD) in the brain, and incident cardiovascular events (CVE). METHODS Data from the ISSYS (Investigating Silent Strokes in hYpertensives Study), which is a longitudinal and observational study conducted in patients with hypertension aged 50-70 years, and stroke-free at the inclusion. At the baseline visit, participants underwent a clinical interview, a brain MRI, urine and blood sampling collection and vascular testing studies. Therefore, we obtained markers of TOD from the brain [white matter hyperintensities, silent brain infarcts (SBI), cerebral microbleeds and enlarged perivascular spaces (EPVS)], from kidney (microalbuminuria, glomerular filtration) and regarding large vessels [ankle-to-brachial index (ABI), carotid-femoral pulse wave velocity]. Survival analyses were used to assess the relationship between these predictors and the incidence of cardiovascular events (CVE). RESULTS We followed-up 964 individuals within a median time of 5 years (4.7-5), representing 4377.1 persons-year. We found 73 patients presenting incident CVE, which corresponds to a rate of 8.2%. We found ABI less than 0.9 [hazard ratio, 2.2; 95% confidence interval (CI) 1.17-4.13, P value = 0.014] and SBI (hazard ratio, 2.9; 95% CI 1.47-5.58, P value = 0.002) independently associated with higher risk of incident CVE. The inclusion of both variables in a clinical model resulted in an increased discrimination of individuals with new CVE of 4.72%, according to the integrated discrimination index. CONCLUSION Assessment of SBI and ABI less than 0.9 may refine the cardiovascular risk stratification in patients with hypertension.
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Lara FR, Scruton AL, Pinheiro A, Demissie S, Parva P, Charidimou A, Francis M, Himali JJ, DeCarli C, Beiser A, Seshadri S, Romero JR. Aging, prevalence and risk factors of MRI-visible enlarged perivascular spaces. Aging (Albany NY) 2022; 14:6844-6858. [PMID: 35852852 PMCID: PMC9512514 DOI: 10.18632/aging.204181] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (CSVD) increases with age and is associated with stroke and cognitive decline. Enlarged Perivascular Spaces (ePVS) is an emerging marker of CSVD, but its prevalence over the life span remain unclear. We characterized the age and sex-specific prevalence of ePVS and relation to age-specific risk factors, in a large community-based sample. METHODS We included 3,710 Framingham Heart Study participants with available brain MRI (average age 61.4±14.6, 46% men). ePVS burden was rated in the centrum semiovale (CSO) and basal ganglia (BG) regions. Individual vascular risk factors were related to ePVS burden in the CSO, BG, and mixed CSO-BG regions using multivariable adjusted ordinal logistic regression analysis. RESULTS Severe ePVS prevalence increased with age in men and women, and paralleled increase in vascular risk factors, and prevention treatment use. Older age, hypertension (and resulting higher treatment use), higher systolic and diastolic blood pressure, and smoking were associated with higher burden of ePVS in the CSO, BG and mixed regions. CONCLUSIONS Our observations reinforce the hypothesis that ePVS may be a marker of aging-driven brain vascular pathologies, and its association with vascular risk factors support their role as CSVD imaging biomarker.
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Affiliation(s)
| | | | - Adlin Pinheiro
- NHLBI’s Framingham Heart Study, Framingham, MA 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Serkalem Demissie
- NHLBI’s Framingham Heart Study, Framingham, MA 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Pedram Parva
- Department of Radiology, Veterans Affairs Boston Health System, Boston, MA 02130, USA
| | - Andreas Charidimou
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
| | | | - Jayandra J. Himali
- NHLBI’s Framingham Heart Study, Framingham, MA 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX 78229, USA
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis, CA 95817, USA
| | - Alexa Beiser
- NHLBI’s Framingham Heart Study, Framingham, MA 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Sudha Seshadri
- NHLBI’s Framingham Heart Study, Framingham, MA 01702, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX 78229, USA
| | - Jose R. Romero
- NHLBI’s Framingham Heart Study, Framingham, MA 01702, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
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Li X, Shen M, Jin Y, Jia S, Zhou Z, Han Z, Zhang X, Tong X, Jiao J. The Effect of Cerebral Small Vessel Disease on the Subtypes of Mild Cognitive Impairment. Front Psychiatry 2021; 12:685965. [PMID: 34335331 PMCID: PMC8322581 DOI: 10.3389/fpsyt.2021.685965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Cerebral small vessel disease (CSVD) is the most common vascular cause of dementia, and mild cognitive impairment (MCI) is an intermediate state between dementia and normal cognitive aging. The present study investigated the main imaging features of CSVD on different MCI subtypes in memory clinics. Methods: A total of 236 patients with MCI and 85 healthy controls were included. One hundred nine amnestic MCI-multiple domains (amMCI), 38 amnestic MCI-single domain (asMCI), 36 non-amnestic MCI-multiple domains (namMCI), and 53 non-amnestic MCI-single domain (nasMCI) patients were diagnosed. All participants were evaluated with the cognitive assessments and imaging features including white matter hyperintensity (WMH), enlarged perivascular spaces (EPVS), cerebral microbleeds (CMBs), and cerebral atrophy according to a standard procedure. Results: The patients with amMCI, namMCI, and nasMCI had more high-grade basal ganglia EPVS compared with healthy controls, while the percentages of high-grade basal ganglia EPVS in the patients with amMCI were also more than those in patients with asMCI, namMCI, and nasMCI. There were more high-grade centrum semiovale EPVS in patients with amMCI in comparison with all other groups. The patients with amMCI and namMCI had more percentages of severe deep and periventricular WMH and deep CMBs compared with healthy controls. All MCI groups had higher scores of the medial temporal lobe atrophy than healthy controls, whereas the scores of the amMCI group were also higher than those of the namMCI and nasMCI groups. Conclusions: There were varied neuroimaging features of CSVD including cerebral atrophy in different MCI groups, which meant that vascular mechanism contributed to the prodromal stage of dementia.
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Affiliation(s)
- Xudong Li
- Department of Cognitive Disorder, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Miaoxin Shen
- Medical School, Xizang Minzu University, Xianyang, China
| | - Yi Jin
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Shuhong Jia
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zhi Zhou
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Ziling Han
- Department of Cognitive Disorder, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiangfei Zhang
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaopeng Tong
- Medical School, Xizang Minzu University, Xianyang, China
| | - Jinsong Jiao
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
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Volumetric distribution of perivascular space in relation to mild cognitive impairment. Neurobiol Aging 2020; 99:28-43. [PMID: 33422892 DOI: 10.1016/j.neurobiolaging.2020.12.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/25/2020] [Accepted: 12/08/2020] [Indexed: 12/19/2022]
Abstract
Vascular contributions to early cognitive decline are increasingly recognized, prompting further investigation into the nature of related changes in perivascular spaces (PVS). Using magnetic resonance imaging, we show that, compared to a cognitively normal sample, individuals with early cognitive dysfunction have altered PVS presence and distribution, irrespective of Amyloid-β. Surprisingly, we noted lower PVS presence in the anterosuperior medial temporal lobe (asMTL) (1.29 times lower PVS volume fraction in cognitively impaired individuals, p < 0.0001), which was associated with entorhinal neurofibrillary tau tangle deposition (beta (standard error) = -0.98 (0.4); p = 0.014), one of the hallmarks of early Alzheimer's disease pathology. We also observed higher PVS volume fraction in centrum semi-ovale of the white matter, but only in female participants (1.47 times higher PVS volume fraction in cognitively impaired individuals, p = 0.0011). We also observed PVS changes in participants with history of hypertension (higher in the white matter and lower in the asMTL). Our results suggest that anatomically specific alteration of the PVS is an early neuroimaging feature of cognitive impairment in aging adults, which is differentially manifested in female.
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Jie W, Lin G, Liu Z, Zhou H, Lin L, Liang G, Ou M, Lin M. The Relationship Between Enlarged Perivascular Spaces and Cognitive Function: A Meta-Analysis of Observational Studies. Front Pharmacol 2020; 11:715. [PMID: 32499704 PMCID: PMC7243265 DOI: 10.3389/fphar.2020.00715] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/30/2020] [Indexed: 01/11/2023] Open
Abstract
Enlarged perivascular spaces (ePVS), visible on magnetic resonance imaging (MRI), are associated with aortic pulse wave changes produced by arterial stiffening. However, the relationship between ePVS and cognition is still unclear. We aimed to benchmark current knowledge of associations between ePVS and cognitive function using a meta-analysis of all available published data. We searched three databases for studies examining ePVS and cognition, identified seven studies involving 7,816 participants, plotted multivariate-adjusted odds ratio (OR) and 95% CI and generated summary OR with a fixed effects model. EPVS were related to the risk of impaired cognition (OR = 1.387, 95% CI = 1.198–1.606, z=4.38, P<0.001) with low heterogeneity. There was publication bias, which could be corrected by trimming and supplementation (OR=1.297, 95% CI= 1.130–1.490). EPVS were associated with impaired cognition and may be a sign of cognitive impairment rather than particular diseases. More studies are required to validate ePVS as a measurable risk marker for cognition using consistent methods to determinea characteristic appearance of ePVS.
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Affiliation(s)
- Wanxin Jie
- Department of Neurology, Institute of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Guanghong Lin
- Medical Intensive Care Unit, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Zhou Liu
- Department of Neurology, Institute of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Haihong Zhou
- Department of Neurology, Institute of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Lifeng Lin
- Department of Neurology, Institute of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Guocong Liang
- Department of Neurology, Institute of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Mingqian Ou
- Department of Neurology, Institute of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Meijun Lin
- Department of Neurology, Institute of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Passiak BS, Liu D, Kresge HA, Cambronero FE, Pechman KR, Osborn KE, Gifford KA, Hohman TJ, Schrag MS, Davis LT, Jefferson AL. Perivascular spaces contribute to cognition beyond other small vessel disease markers. Neurology 2019; 92:e1309-e1321. [PMID: 30814324 PMCID: PMC6511092 DOI: 10.1212/wnl.0000000000007124] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 11/13/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To cross-sectionally relate multiple small vessel disease (SVD) neuroimaging markers to cognition among older adults. METHODS Vanderbilt Memory & Aging Project participants free of clinical dementia and stroke (n = 327, age 73 ± 7 years, 59% male, 40% with mild cognitive impairment) completed neuropsychological assessment and 3T MRI to measure white matter hyperintensities (WMH), perivascular spaces (PVS), cerebral microbleeds (CMBs), and lacunes. Linear regressions related each SVD marker to neuropsychological performances and adjusted for age, sex, race/ethnicity, education, cognitive diagnosis, APOE ε4 presence, Framingham Stroke Risk Profile, and intracranial volume. RESULTS WMH related to the most neuropsychological measures, including the Boston Naming Test, Animal Naming, Coding, Number Sequencing, Executive Function Composite, and Hooper Visual Organization Test performances (p ≤ 0.01). PVS related to multiple information processing and executive function performances (p ≤ 0.02). Lacunes and CMBs related to fewer measures than expected. Combined models simultaneously testing multiple statistically significant SVD predictors suggested that WMH, PVS, and CMBs each independently related to information processing and executive function performances; however, compared to other SVD markers, PVS remained statistically significant in models related to information processing and executive functioning performances. CONCLUSIONS As expected, increased WMH corresponded to poorer performances across multiple cognitive domains. PVS, previously considered a benign neuroimaging feature in older adults, may have important clinical implications because PVS was related to information processing and executive function performances even in combined models. On the basis of models with multiple SVD predictors, WMH, PVS, and CMBs may each reflect a separate pathway of small vessel injury.
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Affiliation(s)
- Brittany S Passiak
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Dandan Liu
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Hailey A Kresge
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Francis E Cambronero
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Kimberly R Pechman
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Katie E Osborn
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Katherine A Gifford
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Timothy J Hohman
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Matthew S Schrag
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - L Taylor Davis
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN
| | - Angela L Jefferson
- From the Vanderbilt Memory & Alzheimer's Center (B.S.P., D.L., H.A.K., F.E.C., K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Neurology (K.R.P., K.E.O., K.A.G., T.J.H., M.S.S., A.L.J.), Department of Biostatistics (D.L.), and Radiology & Radiological Sciences (L.T.D.), Vanderbilt University Medical Center; and Vanderbilt University School of Medicine (B.S.P.), Nashville, TN.
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9
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Francis F, Ballerini L, Wardlaw JM. Perivascular spaces and their associations with risk factors, clinical disorders and neuroimaging features: A systematic review and meta-analysis. Int J Stroke 2019; 14:359-371. [PMID: 30762496 DOI: 10.1177/1747493019830321] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perivascular spaces, visible on brain magnetic resonance imaging, are thought to be associated with small vessel disease, neuroinflammation, and to be important for cerebral hemodynamics and interstitial fluid drainage. AIMS To benchmark current knowledge on perivascular spaces associations with risk factors, neurological disorders, and neuroimaging lesions, using systematic review and meta-analysis. SUMMARY OF REVIEW We searched three databases for perivascular spaces publications, calculated odds ratios with 95% confidence interval and performed meta-analyses to assess adjusted associations with perivascular spaces. We identified 116 relevant studies (n = 36,108) but only 23 (n = 12,725) were meta-analyzable. Perivascular spaces assessment, imaging and clinical definitions varied. Perivascular spaces were associated (n; OR, 95%CI, p) with ageing (8395; 1.47, 1.28-1.69, p = 0.00001), hypertension (7872; 1.67, 1.20-2.31, p = 0.002), lacunes (4894; 3.56, 1.39-9.14, p = 0.008), microbleeds (5015; 2.26, 1.04-4.90, p = 0.04) but not WMH (4974; 1.54, 0.71-3.32, p = 0.27), stroke or cognitive impairment. There was between-study heterogeneity. Lack of appropriate data on other brain disorders and demographic features such as ethnicity precluded analysis. CONCLUSIONS Despite many studies, more are required to determine potential pathophysiological perivascular spaces involvement in cerebrovascular, neurodegenerative and neuroinflammatory disorders.
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Affiliation(s)
- Farah Francis
- 1 Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Lucia Ballerini
- 1 Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- 1 Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK.,2 UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
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10
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Abstract
Cerebral small vessel disease (CSVD) is composed of several diseases affecting the small arteries, arterioles, venules, and capillaries of the brain, and refers to several pathological processes and etiologies. Neuroimaging features of CSVD include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. The main clinical manifestations of CSVD include stroke, cognitive decline, dementia, psychiatric disorders, abnormal gait, and urinary incontinence. Currently, there are no specific preventive or therapeutic measures to improve this condition. In this review, we will discuss the pathophysiology, clinical aspects, neuroimaging, progress of research to treat and prevent CSVD and current treatment of this disease.
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Affiliation(s)
- Qian Li
- 1 Department of Pediatrics, The Third Affiliated Hospital & Field Surgery Institution, Army Medical University, Chongqing, China.,Both the authors contributed equally as co-authors
| | - Yang Yang
- 2 Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Both the authors contributed equally as co-authors
| | - Cesar Reis
- 3 Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Tao Tao
- 2 Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Wanwei Li
- 1 Department of Pediatrics, The Third Affiliated Hospital & Field Surgery Institution, Army Medical University, Chongqing, China
| | - Xiaogang Li
- 2 Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - John H Zhang
- 3 Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA.,4 Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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11
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Liu Y, Dong YH, Lyu PY, Chen WH, Li R. Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment. Chin Med J (Engl) 2018; 131:615-619. [PMID: 29483399 PMCID: PMC5850681 DOI: 10.4103/0366-6999.226069] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Alzheimer's disease and vascular dementia are responsible for more than 80% of dementia cases. These two conditions share common risk factors including hypertension. Cerebral small vessel disease (CSVD) is strongly associated with both hypertension and cognitive impairment. In this review, we identify the pathophysiological changes in CSVD that are caused by hypertension and further explore the relationship between CSVD and cognitive impairment. Data Sources: We searched and scanned the PubMed database for recently published literatures up to December 2017. We used the keywords of “hypertension”, “cerebral small vessel disease”, “white matter lesions”, “enlarged perivascular spaces”, “lacunar infarcts”, “cerebral microbleeds”, and “cognitive impairment” in the database of PubMed. Study Selection: Articles were obtained and reviewed to analyze the hypertension-induced pathophysiological changes that occur in CSVD and the correlation between CSVD and cognitive impairment. Results: In recent years, studies have demonstrated that hypertension-related changes (e.g., small vascular lesions, inflammatory reactions, hypoperfusion, oxidative stress, damage to autoregulatory processes and the blood-brain barrier, and cerebral amyloid angiopathy) can occur over time in cerebral small vessels, potentially leading to lower cognitive function when blood pressure (BP) control is poor or lacking. Both isolated and co-occurrent CSVD can lead to cognitive deterioration, and this effect may be attributable to a dysfunction in either the cholinergic system or the functionality of cortical and subcortical tracts. Conclusions: We explore the currently available evidence about the hypertensive vasculopathy and inflammatory changes that occur in CSVD. Both are vital prognostic indicators of the development of cognitive impairment. Future studies should be performed to validate the relationship between BP levels and CSVD progression and between the numbers, volumes, and anatomical locations of CSVD and cognitive impairment.
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Affiliation(s)
- Yang Liu
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050017; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Yan-Hong Dong
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Pei-Yuan Lyu
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050017; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Wei-Hong Chen
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050017; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Rui Li
- Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050017; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
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12
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Jiménez-Balado J, Riba-Llena I, Garde E, Valor M, Gutiérrez B, Pujadas F, Delgado P. Prevalence of hippocampal enlarged perivascular spaces in a sample of patients with hypertension and their relation with vascular risk factors and cognitive function. J Neurol Neurosurg Psychiatry 2018; 89:651-656. [PMID: 29326289 DOI: 10.1136/jnnp-2017-316724] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/18/2017] [Accepted: 12/11/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The clinical importance of hippocampal enlarged perivascular spaces (H-EPVS) remains uncertain. We aimed to study their association with vascular risk factors, cognitive function and mild cognitive impairment (MCI). METHODS Data were obtained from the ISSYS (Investigating Silent Strokes in hYpertensives, a magnetic resonance imaging Study) cohort, which is a prospective study of patients with hypertension aged 50-70 with no prior stroke or dementia. Participants were clinically evaluated and underwent a cognitive screening test, Dementia Rating Scale-2, which includes five cognitive subscales (attention, initiation/perseveration, conceptualisation, construction and memory). Besides, they were diagnosed with MCI or normal ageing following standard criteria. H-EPVS were manually counted on brain MRI according to a previous scale and defined as extensive when H-EPVS count was ≥7 (upper quartile). Multivariate models were created to study the relationship between H-EPVS, vascular risk factors and cognitive function. RESULTS 723 patients were included; the median age was 64 (59-67) and 51% were male. Seventy-two patients (10%) were diagnosed with MCI and 612 (84.6%) had at least 1 H-EPVS. Older age (OR per year=1.04, 95% CI 1.01 to 1.08) and poor blood pressure treatment compliance (OR=1.50, 95% CI 1.07 to 2.11) were independently associated with extensive H-EPVS. Regarding cognitive function, H-EPVS were independently and inversely correlated with verbal reasoning (β=-0.021, 95% CI -0.038 to -0.003). No association was found between H-EPVS and MCI. CONCLUSIONS H-EPVS are a frequent finding in patients with hypertension and are associated with ageing and poor hypertension treatment compliance. Besides, H-EPVS are associated with worse verbal reasoning function.
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Affiliation(s)
- Joan Jiménez-Balado
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Iolanda Riba-Llena
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edurne Garde
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Valor
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Belen Gutiérrez
- Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Pujadas
- Dementia Unit, Neurology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Schapira AHV. Advances and insights into neurological practice 2016−17. Eur J Neurol 2017; 24:1425-1434. [DOI: 10.1111/ene.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Dichgans M, Leys D. Vascular Cognitive Impairment. Circ Res 2017; 120:573-591. [PMID: 28154105 DOI: 10.1161/circresaha.116.308426] [Citation(s) in RCA: 291] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/28/2016] [Accepted: 08/29/2016] [Indexed: 01/10/2023]
Abstract
Cerebrovascular disease typically manifests with stroke, cognitive impairment, or both. Vascular cognitive impairment refers to all forms of cognitive disorder associated with cerebrovascular disease, regardless of the specific mechanisms involved. It encompasses the full range of cognitive deficits from mild cognitive impairment to dementia. In principle, any of the multiple causes of clinical stroke can cause vascular cognitive impairment. Recent work further highlights a role of microinfarcts, microhemorrhages, strategic white matter tracts, loss of microstructural tissue integrity, and secondary neurodegeneration. Vascular brain injury results in loss of structural and functional connectivity and, hence, compromise of functional networks within the brain. Vascular cognitive impairment is common both after stroke and in stroke-free individuals presenting to dementia clinics, and vascular pathology frequently coexists with neurodegenerative pathology, resulting in mixed forms of mild cognitive impairment or dementia. Vascular dementia is now recognized as the second most common form of dementia after Alzheimer's disease, and there is increasing awareness that targeting vascular risk may help to prevent dementia, even of the Alzheimer type. Recent advances in neuroimaging, neuropathology, epidemiology, and genetics have led to a deeper understanding of how vascular disease affects cognition. These new findings provide an opportunity for the present reappraisal of vascular cognitive impairment. We further briefly address current therapeutic concepts.
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Affiliation(s)
- Martin Dichgans
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.).
| | - Didier Leys
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.)
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15
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Kamchatnov PR, Chugunov AV, Tyazhelnikov AA, Pyshkina LI. Pathogenesis of chronic disorders of cerebral circulation. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:70-77. [DOI: 10.17116/jnevro201711712270-77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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16
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Calabrese V, Giordano J, Signorile A, Laura Ontario M, Castorina S, De Pasquale C, Eckert G, Calabrese EJ. Major pathogenic mechanisms in vascular dementia: Roles of cellular stress response and hormesis in neuroprotection. J Neurosci Res 2016; 94:1588-1603. [PMID: 27662637 DOI: 10.1002/jnr.23925] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 12/18/2022]
Abstract
Vascular dementia (VaD), considered the second most common cause of cognitive impairment after Alzheimer disease in the elderly, involves the impairment of memory and cognitive function as a consequence of cerebrovascular disease. Chronic cerebral hypoperfusion is a common pathophysiological condition frequently occurring in VaD. It is generally associated with neurovascular degeneration, in which neuronal damage and blood-brain barrier alterations coexist and evoke beta-amyloid-induced oxidative and nitrosative stress, mitochondrial dysfunction, and inflammasome- promoted neuroinflammation, which contribute to and exacerbate the course of disease. Vascular cognitive impairment comprises a heterogeneous group of cognitive disorders of various severity and types that share a presumed vascular etiology. The present study reviews major pathogenic factors involved in VaD, highlighting the relevance of cerebrocellular stress and hormetic responses to neurovascular insult, and addresses these mechanisms as potentially viable and valuable as foci of novel neuroprotective methods to mitigate or prevent VaD. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Vittorio Calabrese
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy.
| | - James Giordano
- Departments of Neurology and Biochemistry and Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC
| | - Anna Signorile
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Maria Laura Ontario
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Sergio Castorina
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Concetta De Pasquale
- Department of Medical, Surgical Sciences and Advanced Technologies, University of Catania, Italy
| | - Gunter Eckert
- Institute of Nutrition Sciences, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Edward J Calabrese
- Department of Environmental Health Sciences, University of Massachusetts, Amherst, Amherst, Massachusetts
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