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van der Holst HM, Tuladhar AM, Zerbi V, van Uden IWM, de Laat KF, van Leijsen EMC, Ghafoorian M, Platel B, Bergkamp MI, van Norden AGW, Norris DG, van Dijk EJ, Kiliaan AJ, de Leeuw FE. White matter changes and gait decline in cerebral small vessel disease. Neuroimage Clin 2017; 17:731-738. [PMID: 29270357 PMCID: PMC5730123 DOI: 10.1016/j.nicl.2017.12.007] [Citation(s) in RCA: 56] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/09/2017] [Accepted: 12/04/2017] [Indexed: 12/23/2022]
Abstract
The relation between progression of cerebral small vessel disease (SVD) and gait decline is uncertain, and diffusion tensor imaging (DTI) studies on gait decline are lacking. We therefore investigated the longitudinal associations between (micro) structural brain changes and gait decline in SVD using DTI. 275 participants were included from the Radboud University Nijmegen Diffusion tensor and Magnetic resonance imaging Cohort (RUN DMC), a prospective cohort of participants with cerebral small vessel disease aged 50-85 years. Gait (using GAITRite) and magnetic resonance imaging measures were assessed during baseline (2006-2007) and follow-up (2011 - 2012). Linear regression analysis was used to investigate the association between changes in conventional magnetic resonance and diffusion tensor imaging measures and gait decline. Tract-based spatial statistics analysis was used to investigate region-specific associations between changes in white matter integrity and gait decline. 56.2% were male, mean age was 62.9 years (SD8.2), mean follow-up duration was 5.4 years (SD0.2) and mean gait speed decline was 0.2 m/s (SD0.2). Stride length decline was associated with white matter atrophy (β = 0.16, p = 0.007), and increase in mean white matter radial diffusivity and mean diffusivity, and decrease in mean fractional anisotropy (respectively, β = - 0.14, p = 0.009; β = - 0.12, p = 0.018; β = 0.10, p = 0.049), independent of age, sex, height, follow-up duration and baseline stride length. Tract-based spatial statistics analysis showed significant associations between stride length decline and fractional anisotropy decrease and mean diffusivity increase (primarily explained by radial diffusivity increase) in multiple white matter tracts, with the strongest associations found in the corpus callosum and corona radiata, independent of traditional small vessel disease markers. White matter atrophy and loss of white matter integrity are associated with gait decline in older adults with small vessel disease after 5 years of follow-up. These findings suggest that progression of SVD might play an important role in gait decline.
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Affiliation(s)
- H M van der Holst
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - A M Tuladhar
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - V Zerbi
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Anatomy, 6521 EZ Nijmegen, The Netherlands; Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zürich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - I W M van Uden
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - K F de Laat
- HagaZiekenhuis Den Haag, Department of Neurology, Leyweg 275, 2545 CH Den Haag, The Netherlands
| | - E M C van Leijsen
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - M Ghafoorian
- Radboud University Medical Centre, Department of radiology and nuclear medicine, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - B Platel
- Radboud University Medical Centre, Department of radiology and nuclear medicine, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - M I Bergkamp
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - A G W van Norden
- Amphia ziekenhuis Breda, Department of Neurology, Molengracht 21, 4818 CK Breda, The Netherlands
| | - D G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging, UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Arendahls Wiese 199, D-45141 Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, 7500 AE Enschede, The Netherlands
| | - E J van Dijk
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands
| | - A J Kiliaan
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Anatomy, 6521 EZ Nijmegen, The Netherlands
| | - F-E de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Reinier Postlaan 4, 6500HB Nijmegen, The Netherlands.
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van Uden IWM, Tuladhar AM, van der Holst HM, van Leijsen EMC, van Norden AGW, de Laat KF, Rutten-Jacobs LCA, Norris DG, Claassen JAHR, van Dijk EJ, Kessels RPC, de Leeuw FE. Diffusion tensor imaging of the hippocampus predicts the risk of dementia; the RUN DMC study. Hum Brain Mapp 2016; 37:327-37. [PMID: 26468058 PMCID: PMC6867248 DOI: 10.1002/hbm.23029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 07/16/2015] [Revised: 09/10/2015] [Accepted: 10/07/2015] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Cerebral small vessel disease is one of the most important risk factors for dementia, and has been related to hippocampal atrophy, which is among the first observed changes on conventional MRI in patients with dementia. However, these volumetric changes might be preceded by loss of microstructural integrity of the hippocampus for which conventional MRI is not sensitive enough. Therefore, we investigated the relation between the hippocampal diffusion parameters and the risk of incident dementia, using diffusion tensor imaging, independent of hippocampal volume. METHODS The RUNDMC study is a prospective study among 503 elderly with small vessel disease, without dementia, with 5 years follow-up in 2012 (99.6% response-rate). Cox regression analysis was performed to calculate hazard ratios for dementia, of fractional anisotropy and mean diffusivity within the hippocampus, adjusted for demographics, hippocampal volume, and white matter. This was repeated in participants without evident hippocampal volume loss, because in these participants the visible damage might not yet have already started, whereas damage might have started on a microstructural level. RESULTS 43 participants developed dementia (8.6%), resulting in a 5.5-year cumulative risk of 11.1% (95%CI 7.7-14.6). Higher mean diffusivity was associated with an increased 5-year risk of dementia. In the subgroup of participants with the upper half hippocampal volume, higher hippocampal mean diffusivity, more than doubled the 5-year risk of dementia. CONCLUSION This is the first prospective study showing a relation between a higher baseline hippocampal mean diffusivity and the risk of incident dementia in elderly with small vessel disease at 5-year follow-up, independent of hippocampal volume and white matter volume.
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Affiliation(s)
- I W M van Uden
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - A M Tuladhar
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - H M van der Holst
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - E M C van Leijsen
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - A G W van Norden
- Department of Neurology, Amphia Ziekenhuis Breda, The Netherlands
| | - K F de Laat
- Department of Neurology, HagaZiekenhuis Den Haag, The Netherlands
| | - L C A Rutten-Jacobs
- Department of Clinical Neurosciences, Neurology Unit, University of Cambridge, United Kingdom
| | - D G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, The Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, D-45141, Germany
| | - J A H R Claassen
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Geriatrics, The Netherlands
| | - E J van Dijk
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
| | - R P C Kessels
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Geriatrics, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Medical Psychology, The Netherlands
| | - F-E de Leeuw
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, The Netherlands
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van der Holst HM, Tuladhar AM, van Norden AGW, de Laat KF, van Uden IWM, van Oudheusden LJB, Zwiers MP, Norris DG, Kessels RPC, de Leeuw FE. Microstructural integrity of the cingulum is related to verbal memory performance in elderly with cerebral small vessel disease: the RUN DMC study. Neuroimage 2012; 65:416-23. [PMID: 23032491 DOI: 10.1016/j.neuroimage.2012.09.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/24/2012] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cerebral small vessel disease (SVD) is related to verbal memory failures. It is suggested that early white matter damage, is located, among others, in the (posterior) cingulum at an early stage in neurodegeneration. Changes in the microstructural integrity of the cingulum assessed with diffusion tensor imaging (DTI), beyond detection with conventional MRI, may precede macrostructural changes and be related to verbal memory failures. OBJECTIVE To investigate the relation between cingular microstructural integrity and verbal memory performance in 503 non-demented elderly with cerebral SVD. METHODS The RUN DMC study is a prospective cohort study in elderly (50-85 years) with cerebral SVD. All participants underwent T1 MPRAGE, FLAIR and DTI scanning and the Rey Auditory Verbal Learning Test. Mean diffusivity (MD) and fractional anisotropy (FA) were assessed in six different cingular regions of interests (ROIs). Linear regression analysis was used to assess the relation between verbal memory performance and cingular DTI parameters, with appropriate adjustments. Furthermore a TBSS analysis of the whole brain was performed to investigate the specificity of our findings. RESULTS Both our ROI-based and TBSS analysis showed that FA was positively related to immediate memory, delayed recall, delayed recognition and overall verbal memory performance of the cingulum, independent of confounders. A similar distribution was seen for the inverse association with MD and verbal memory performance with TBSS analysis. No significant relations were found with psychomotor speed, visuospatial memory and MMSE. When stratified on hippocampal integrity, the MD and FA values of the cingular ROIs differed significantly between participants with a good and poor hippocampal integrity. CONCLUSION Microstructural integrity of the cingulum, assessed by DTI, is specifically related to verbal memory performance, in elderly with SVD. Furthermore we found that when the integrity of the hippocampus is disrupted, the cingulum integrity is impaired as well.
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Affiliation(s)
- H M van der Holst
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
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van Uden IWM, van Norden AGW, de Laat KF, van Oudheusden LJB, Gons RAR, Tendolkar I, Zwiers MP, de Leeuw FE. Depressive Symptoms and Amygdala Volume in Elderly with Cerebral Small Vessel Disease: The RUN DMC Study. J Aging Res 2011; 2011:647869. [PMID: 22007299 PMCID: PMC3189594 DOI: 10.4061/2011/647869] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 08/13/2011] [Indexed: 01/08/2023] Open
Abstract
Introduction. Late onset depressive symptoms (LODSs) frequently occur in elderly with cerebral small vessel disease (SVD). SVD cannot fully explain LODS; a contributing factor could be amygdala volume. We investigated the relation between amygdala volume and LODS, independent of SVD in 503 participants with symptomatic cerebral SVD. Methods. Patients underwent FLAIR and T1 scanning. Depressive symptoms were assessed with structured questionnaires; amygdala and WML were manually segmented. The relation between amygdala volume and LODS/EODS was investigated and adjusted for age, sex, intracranial volume, and SVD. Results. Patients with LODS had a significantly lower left amygdala volume than those without (P = 0.02), independent of SVD. Each decrease of total amygdala volume (by mL) was related to an increased risk of LODS (OR = 1.77; 95% CI 1.02–3.08; P = 0.04).
Conclusion. Lower left amygdala volume is associated with LODS, independent of SVD. This may suggest differential mechanisms, in which individuals with a small amygdala might be vulnerable to develop LODS.
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Affiliation(s)
- I W M van Uden
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Reinier Postlaan 4, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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de Leeuw FE, van Norden AGW, van der Flier WM, Olde Rikkert MGM, Scheltens P. [Alzheimer's disease and treatment of vascular risk factors]. Ned Tijdschr Geneeskd 2005; 149:2844-9. [PMID: 16398165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
There is increasing evidence that vascular risk factors including hypertension, high cholesterol, hyperhomocysteinaemia and diabetes mellitus are connected to the risk of Alzheimer's disease (AD). The risk of AD may be reduced by the treatment of hypertension prior to onset of cognitive impairment. One small randomised clinical trial has provided some evidence of beneficial effects on cognition of cholesterol-lowering drugs such as the statins in patients with AD. Treatment of hypertension, hyperhomocysteinaemia and diabetes mellitus with the aim of halting the progression of cognitive decline in AD is still under study and results are awaited. For the time being findings from the trials carried out thus far should be interpreted with care due to methodological shortcomings, both in study design and execution. In order to investigate the role of vascular risk factors both in the aetiology and treatment of AD, large prospective randomised trials with long-term follow-up of AD patients who have been diagnosed using revised uniform diagnostic criteria that take the heterogeneity of the disease into account, are necessary.
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Affiliation(s)
- F E de Leeuw
- Universitair Medisch Centrum St Radboud, Huispostnummer 326, Postbus gIoI, 6500 HB Nijmegen.
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Abstract
BACKGROUND Magnesium is a neuroprotective agent that might prevent or reverse delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). We are presently running a randomized, placebo-controlled, double blind trial with magnesium sulphate (64 mmol/day intravenously). We studied whether this treatment regime resulted in our target serum magnesium levels of 1.0-2.0 mmol/L. METHODS Magnesium sulphate was administered intravenously as soon as possible after admission and continued until 14 days after occlusion of the aneurysm. Serum magnesium measurements were done at baseline and at least every 2 days during administration of trial medication. For comparison we used the serum magnesium levels of the placebo-treated patients. RESULTS Magnesium therapy was begun in 94 patients. The mean magnesium level in the treatment period was 1.47 +/- 0.32 mmol/L. In 81 patients serum magnesium stayed within target levels during the entire treatment period. One patient had a serum magnesium level below 1.0 mmol/L (0.91 mmol/L) in a single measurement and 10 patients had serum magnesium levels above 2.0 mmol/L at one or more measurements. In six patients magnesium therapy was discontinued: in three because of nausea, headache, or both in combination with serum magnesium levels above 2.0 mmol/L and in the other three because of hypotension, phlebitis and renal failure. CONCLUSIONS With an intravenous dosage schedule of 64 mmol magnesium sulphate a day, serum magnesium levels of 1.0-2.0 mmol/L can easily be maintained without severe side effects for an extended period in a vast majority of patients with SAH.
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Affiliation(s)
- A G W van Norden
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
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