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Shang X, Zhang X, Huang Y, Zhu Z, Zhang X, Liu J, Wang W, Tang S, Yu H, Ge Z, Yang X, He M. Association of a wide range of individual chronic diseases and their multimorbidity with brain volumes in the UK Biobank: A cross-sectional study. EClinicalMedicine 2022; 47:101413. [PMID: 35518119 PMCID: PMC9065617 DOI: 10.1016/j.eclinm.2022.101413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/27/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Little is known regarding associations of conventional and emerging diseases and their multimorbidity with brain volumes. METHODS This cross-sectional study included 36,647 European ancestry individuals aged 44-81 years with brain magnetic resonance imaging data from UK Biobank. Brain volumes were measured between 02 May 2014 and 31 October 2019. General linear regression models were used to associate 57 individual major diseases with brain volumes. Latent class analysis was used to identify multimorbidity patterns. A multimorbidity score for brain volumes was computed based on the estimates for individual groups of diseases. FINDINGS Out of 57 major diseases, 16 were associated with smaller volumes of total brain, 14 with smaller volumes of grey matter, and six with smaller hippocampus volumes, and four major diseases were associated with higher white matter hyperintensity (WMH) load after adjustment for all other diseases. The leading contributors to the variance of total brain volume were hypertension (R2=0·0229), dyslipidemia (0·0190), cataract (0·0176), coronary heart disease (0·0107), and diabetes (0·0077). We identified six major multimorbidity patterns and multimorbidity patterns of cardiometabolic disorders (CMD), and CMD-multiple disorders, and metabolic disorders were independently associated with smaller volumes of total brain (β (95% CI): -6·6 (-8·9, -4·3) ml, -7·3 (-10·4, -4·1) ml, and -10·4 (-13·5, -7·3) ml, respectively), grey matter (-7·1 (-8·5, -5·7) ml, -9·0 (-10·9, -7·1) ml, and -11·8 (-13·6, -9·9) ml, respectively), and higher WMH load (0·23 (0·19, 0·27), 0·25 (0·19, 0·30), and 0·33 (0·27, 0·39), respectively) after adjustment for geographic, socioeconomic, and lifestyle factors (all P-values<0·0001). The percentage of the variance of total brain volume explained by multimorbidity patterns, multimorbidity defined by the number of diseases, and multimorbidity score was 1·2%, 3·1%, and 7·2%, respectively. Associations between CMD-multiple disorders pattern, and metabolic disorders pattern and volumes of total brain, grey matter, and WMH were stronger in men than in women. Associations between multimorbidity and brain volumes were stronger in younger than in older individuals. INTERPRETATION Besides conventional diseases, we found an association between numerous emerging diseases and smaller brain volumes. CMD-related multimorbidity patterns are associated with smaller brain volumes. Men or younger adults with multimorbidity are more in need of care for promoting brain health. These findings are from an association study and will need confirmation. FUNDING The Fundamental Research Funds of the State Key Laboratory of Ophthalmology, Project of Investigation on Health Status of Employees in Financial Industry in Guangzhou, China (Z012014075), Science and Technology Program of Guangzhou, China (202,002,020,049).
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Key Words
- AD, Alzheimer’s disease
- APOE4, Apolipoprotein E ε4
- BMI, body mass index
- Brain volume
- CHD, coronary heart disease
- CI, confidence interval
- CKD, chronic kidney disease
- CMD, cardiometabolic disorders
- COPD, chronic obstructive pulmonary disease
- CVD, cardiovascular disease
- FDR, false discovery rate
- Grey matter
- Hippocampus
- Major diseases
- Moderation analysis
- Multimorbidity
- OLS, ordinary least squares
- WMH, white matter hyperintensity
- White matter hyperintensity
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Affiliation(s)
- Xianwen Shang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Centre for Eye Research Australia, The University of Melbourne, Level 7, 32 Gisborne Street, Melbourne, VIC 3002, Australia
- Corresponding authors at: Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China.
| | - Xueli Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Yu Huang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhuoting Zhu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Centre for Eye Research Australia, The University of Melbourne, Level 7, 32 Gisborne Street, Melbourne, VIC 3002, Australia
| | - Xiayin Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiahao Liu
- Centre for Eye Research Australia, The University of Melbourne, Level 7, 32 Gisborne Street, Melbourne, VIC 3002, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Shulin Tang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Zongyuan Ge
- Monash e-Research Center, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Center, Monash University, Melbourne, VIC 3800, Australia
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Mingguang He
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China
- Centre for Eye Research Australia, The University of Melbourne, Level 7, 32 Gisborne Street, Melbourne, VIC 3002, Australia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Corresponding authors at: Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, Guangdong 510080, China.
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Blair GW, Stringer MS, Thrippleton MJ, Chappell FM, Shuler K, Hamilton I, Garcia DJ, Doubal FN, Kopczak A, Duering M, Ingrisch M, Kerkhofs D, Staals J, van den Brink H, Arts T, Backes WH, van Oostenbrugge R, Biessels GJ, Dichgans M, Wardlaw JM. Imaging neurovascular, endothelial and structural integrity in preparation to treat small vessel diseases. The INVESTIGATE-SVDs study protocol. Part of the SVDs@Target project. Cereb Circ Cogn Behav 2021; 2:100020. [PMID: 36324725 DOI: 10.1016/j.cccb.2021.100020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/25/2021] [Accepted: 06/20/2021] [Indexed: 12/30/2022]
Abstract
Background Sporadic cerebral small vessel disease (SVD) and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) share clinical and neuroimaging features and possibly vascular dysfunction(s). However few studies have included both conditions, assessed more than one vascular dysfunction simultaneously, or included more than one centre. The INVESTIGATE-SVDs study will assess several cerebrovascular dysfunctions with MRI in participants with sporadic SVD or CADASIL at three European centres. Methods We will recruit participants with sporadic SVDs (ischaemic stroke or vascular cognitive impairment) and CADASIL in Edinburgh, Maastricht and Munich. We will perform detailed clinical and neuropsychological phenotyping of the participants, and neuroimaging including structural MRI, cerebrovascular reactivity MRI (CVR: using carbon dioxide challenge), phase contrast MRI (arterial, venous and CSF flow and pulsatility), dynamic contrast-enhanced MRI (blood brain barrier (BBB) leakage) and multishell diffusion imaging. Participants will measure their blood pressure (BP) and its variability over seven days using a telemetric device. Discussion INVESTIGATE-SVDs will assess the relationships of BBB integrity, CVR, pulsatility and CSF flow in sporadic SVD and CADASIL using a multisite, multimodal MRI protocol. We aim to establish associations between these measures of vascular function, risk factors particularly BP and its variability, and brain parenchymal lesions in these two SVD phenotypes. Additionally we will test feasibility of complex multisite MRI, provide reliable intermediary outcome measures and sample size estimates for future trials.
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Key Words
- BBB, blood brain barrier
- BOLD, blood oxygen level dependent
- BP, blood pressure
- BPv, blood pressure variability
- Blood-brain barrier permeability
- CADASIL
- CADASIL, cerebral autosomal dominant arteriopathy with leukoencephalopathy and subcortical infarcts
- CBF, cerebral blood flow
- CERAD+, consortium to establish a disease registry for Alzheimer's disease plus battery
- CO2, carbon dioxide
- CSF, cerebrospinal fluid
- CVR, cerebrovascular reactivity
- Cerebral small vessel disease
- Cerebrovascular reactivity
- DCE, dynamic contrast enhanced
- EtCO2, end-tidal carbon dioxide
- GM, grey matter
- MMSE, mini-mental state examination
- MRI
- MoCA, Montreal cognitive exam
- NIHSS, national institute for health stroke scale
- PI, pulsatility index
- PVS, perivascular space
- RSSI, recent small subcortical infarct
- SVDs, small vessel diseases
- WM, white matter
- WMH, white matter hyperintensity
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Yoshida M, Kato N, Uemura T, Mizoi M, Nakamura M, Saiki R, Hatano K, Sato K, Kakizaki S, Nakamura A, Ishii T, Terao T, Murayama Y, Kashiwagi K, Igarashi K. Time dependent transition of the levels of protein-conjugated acrolein (PC-Acro), IL-6 and CRP in plasma during stroke. eNeurologicalSci 2017; 7:18-24. [PMID: 29260020 PMCID: PMC5721576 DOI: 10.1016/j.ensci.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/09/2017] [Accepted: 03/24/2017] [Indexed: 01/28/2023] Open
Abstract
Objective Measurement of plasma levels of protein-conjugated acrolein (PC-Acro) together with IL-6 and CRP can be used to identify silent brain infarction (SBI) with high sensitivity and specificity. The aim of this study was to determine how these biomarkers vary during stroke. Methods Levels of PC-Acro, IL-6 and CRP in plasma were measured on day 0, 2, 7 and 14 after the onset of ischemic or hemorrhagic stroke. Results After the onset of stroke, the level of PC-Acro in plasma was elevated corresponding to the size of stroke. It returned to near control levels by day 2, and remained similar through day 14. The degree of the decrease in PC-Acro on day 2 was greater when the size of brain infarction or hemorrhage was larger. An increase in IL-6 and CRP occurred after the increase in PC-Acro, and it was well correlated with the size of the injury following infarction or hemorrhage. The results suggest that acrolein becomes a trigger for the production of IL-6 and CRP, as previously observed in a mouse model of stroke and in cell culture systems. The increase in IL-6 and CRP was also correlated with poor outcome judging from mRS. Conclusion The results indicate that the degree of the decrease in PC-Acro and the increase in IL-6 and CRP from day 0 to day 2 was correlated with the size of brain infarction, and the increase in IL-6 and CRP with poor outcome at discharge.
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Affiliation(s)
- Madoka Yoshida
- Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba, Chiba, Japan
| | - Naoki Kato
- Department of Neurosurgery, Atsugi Municipal Hospital, Atsugi, Kanagawa, Japan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takeshi Uemura
- Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba, Chiba, Japan
| | - Mutsumi Mizoi
- Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba, Chiba, Japan
| | - Mizuho Nakamura
- Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba, Chiba, Japan
| | - Ryotaro Saiki
- Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba, Chiba, Japan
| | - Keisuke Hatano
- Department of Neurosurgery, Atsugi Municipal Hospital, Atsugi, Kanagawa, Japan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kunitomo Sato
- Department of Neurosurgery, Atsugi Municipal Hospital, Atsugi, Kanagawa, Japan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shota Kakizaki
- Department of Neurosurgery, Atsugi Municipal Hospital, Atsugi, Kanagawa, Japan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Aya Nakamura
- Department of Neurosurgery, Atsugi Municipal Hospital, Atsugi, Kanagawa, Japan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takuya Ishii
- Department of Neurosurgery, Atsugi Municipal Hospital, Atsugi, Kanagawa, Japan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Tohru Terao
- Department of Neurosurgery, Atsugi Municipal Hospital, Atsugi, Kanagawa, Japan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Keiko Kashiwagi
- Faculty of Pharmacy, Chiba Institute of Science, Choshi, Chiba, Japan
| | - Kazuei Igarashi
- Amine Pharma Research Institute, Innovation Plaza at Chiba University, Chiba, Chiba, Japan
- Graduate School of Pharmaceutical Sciences, Chiba University, Chiba, Chiba, Japan
- Corresponding author at: Amine Pharma Research Institute, Innovation Plaza at Chiba University, 1-8-15 Inohana, Chuo-ku, Chiba, Chiba 260-0856, Japan.
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Wong SM, Zhang CE, van Bussel FC, Staals J, Jeukens CR, Hofman PA, van Oostenbrugge RJ, Backes WH, Jansen JF. Simultaneous investigation of microvasculature and parenchyma in cerebral small vessel disease using intravoxel incoherent motion imaging. Neuroimage Clin 2017; 14:216-221. [PMID: 28180080 PMCID: PMC5288390 DOI: 10.1016/j.nicl.2017.01.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/28/2016] [Accepted: 01/16/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Cerebral small vessel disease (cSVD) is associated with microvascular and parenchymal alterations. Intravoxel incoherent motion (IVIM) MRI has been proposed to simultaneously measure both the microvascular perfusion and parenchymal diffusivity. This study aimed to evaluate the application of IVIM in cSVD to assess the microvasculature and parenchymal microstructure. METHODS Seventy-three patients with cSVD (age 70 ± 11 y) and thirty-nine controls (age 69 ± 12 y) underwent IVIM imaging (3T). Group differences of the perfusion volume fraction f and the parenchymal diffusivity D were investigated using multivariable linear regression accounted for age, sex and cardiovascular factors. To examine the relation between the IVIM measures and the disease severity on structural MRI, white matter hyperintensity (WMH) load served as surrogate measure of the disease severity. RESULTS Patients had a larger f (p < 0.024) in the normal appearing white matter (NAWM) than controls. Higher D (p < 0.031) was also observed for patients compared with controls in the NAWM and grey matter. Both f (p < 0.024) and D (p < 0.001) in the NAWM and grey matter increased with WMH load. CONCLUSIONS The increased diffusivity reflects the predicted microstructural tissue impairment in cSVD. Unexpectedly, an increased perfusion volume fraction was observed in patients. Future studies are needed to reveal the precise nature of the increased perfusion volume fraction. IVIM imaging showed that the increases of f and D in cSVD were both related to disease severity, which suggests the potential of IVIM imaging to provide a surrogate marker for the progression of cSVD.
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Key Words
- BMI, body mass index
- Brain parenchyma
- Cerebral small vessel disease
- DGM, deep grey matter
- DW, diffusion weighted
- Diffusion weighted imaging
- FLAIR, fluid attenuated inversion recovery
- FOV, field of view
- IVIM, intravoxel incoherent motion imaging
- Intravoxel incoherent motion imaging
- LS, lacunar stroke
- Microvasculature
- NAWM, normal appearing white matter
- PVS, perivascular spaces
- Perfusion MR imaging
- ROI, region of interest
- SNR, signal-to-noise ratio
- WMH, white matter hyperintensity
- cSVD, cerebral small vessel disease
- mVCI, mild vascular cognitive impairment
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Affiliation(s)
- Sau May Wong
- Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C. Eleana Zhang
- Dept. of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands
- Dept. of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frank C.G. van Bussel
- Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Julie Staals
- Dept. of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Dept. of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cécile R.L.P.N. Jeukens
- Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paul A.M. Hofman
- Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert J. van Oostenbrugge
- Dept. of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands
- Dept. of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Walter H. Backes
- Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jacobus F.A. Jansen
- Dept. of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre, Maastricht, The Netherlands
- Corresponding author at: Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands.Department of Radiology & Nuclear MedicineMaastricht University Medical CentrePO Box 5800Maastricht6202 AZThe Netherlands
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Switzer AR, McCreary C, Batool S, Stafford RB, Frayne R, Goodyear BG, Smith EE. Longitudinal decrease in blood oxygenation level dependent response in cerebral amyloid angiopathy. Neuroimage Clin 2016; 11:461-467. [PMID: 27104140 PMCID: PMC4827726 DOI: 10.1016/j.nicl.2016.02.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/19/2015] [Revised: 02/05/2016] [Accepted: 02/29/2016] [Indexed: 02/07/2023]
Abstract
Lower blood oxygenation level dependent (BOLD) signal changes in response to a visual stimulus in functional magnetic resonance imaging (fMRI) have been observed in cross-sectional studies of cerebral amyloid angiopathy (CAA), and are presumed to reflect impaired vascular reactivity. We used fMRI to detect a longitudinal change in BOLD responses to a visual stimulus in CAA, and to determine any correlations between these changes and other established biomarkers of CAA progression. Data were acquired from 22 patients diagnosed with probable CAA (using the Boston Criteria) and 16 healthy controls at baseline and one year. BOLD data were generated from the 200 most active voxels of the primary visual cortex during the fMRI visual stimulus (passively viewing an alternating checkerboard pattern). In general, BOLD amplitudes were lower at one year compared to baseline in patients with CAA (p = 0.01) but were unchanged in controls (p = 0.18). The longitudinal difference in BOLD amplitudes was significantly lower in CAA compared to controls (p < 0.001). White matter hyperintensity (WMH) volumes and number of cerebral microbleeds, both presumed to reflect CAA-mediated vascular injury, increased over time in CAA (p = 0.007 and p = 0.001, respectively). Longitudinal increases in WMH (rs = 0.04, p = 0.86) or cerebral microbleeds (rs = − 0.18, p = 0.45) were not associated with the longitudinal decrease in BOLD amplitudes. Visual fMRI was performed in CAA and controls at baseline and at one year. BOLD response amplitude was lower at one year compared to baseline in CAA. BOLD response amplitude decreases were not seen in similarly-aged controls. Progressive impairment in vascular reactivity may be a feature of CAA. Decreased BOLD response amplitude was unrelated to other CAA-related vascular changes.
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Affiliation(s)
- Aaron R Switzer
- Neuroscience Graduate Program, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Cheryl McCreary
- Department of Radiology, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Saima Batool
- Department of Clinical Neurosciences, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Randall B Stafford
- Department of Clinical Neurosciences, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Richard Frayne
- Neuroscience Graduate Program, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Bradley G Goodyear
- Neuroscience Graduate Program, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Eric E Smith
- Neuroscience Graduate Program, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada.
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Berman SE, Wang X, Mitchell CC, Kundu B, Jackson DC, Wilbrand SM, Varghese T, Hermann BP, Rowley HA, Johnson SC, Dempsey RJ. The relationship between carotid artery plaque stability and white matter ischemic injury. Neuroimage Clin 2015; 9:216-22. [PMID: 26448914 PMCID: PMC4572385 DOI: 10.1016/j.nicl.2015.08.011] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/17/2015] [Accepted: 08/17/2015] [Indexed: 12/12/2022]
Abstract
Higher local carotid artery strain has previously been shown to be a characteristic of unstable carotid plaques. These plaques may be characterized by microvascular changes that predispose to intraplaque hemorrhage, increasing the likelihood of embolization. Little is known however, about how these strain indices correspond with imaging markers of brain health and metrics of brain structure. White matter hyperintensities (WMHs), which are bright regions seen on T2-weighted brain MRI imaging, are postulated to result from cumulative ischemic vascular injury. Consequently, we hypothesized that plaques that are more prone to microvascular changes and embolization, represented by higher strain indices on ultrasound, would be associated with an increased amount of WMH lesion volume. This relationship would suggest not only emboli as a cause for the brain degenerative changes, but more importantly, a common microvascular etiology for large and small vessel contributions to this process. Subjects scheduled to undergo a carotid endarterectomy were recruited from a neurosurgery clinic. Prior to surgery, participating subjects underwent both ultrasound strain imaging and brain MRI scans as part of a larger clinical study on vascular health and cognition. A linear regression found that maximum absolute strain and peak to peak strain in the surgical side carotid artery were predictive of WMH burden. Furthermore, the occurrence of microembolic signals monitored using transcranial Doppler (TCD) ultrasound examinations also correlated with increasing lesion burden. It is becoming increasingly recognized that cognitive decline is often multifactorial in nature. One contributing extra-brain factor may be changes in the microvasculature that produce unstable carotid artery plaques. In this study, we have shown that higher strain indices in carotid artery plaques are significantly associated with an increased WMH burden, a marker of vascular mediated brain damage. We examine how carotid artery plaque strain indices correspond with MRI metrics. Strain in the ICA predicts increased white matter hyperintensity lesion burden. Subjects with embolizing plaques have greater white matter lesion burden.
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Affiliation(s)
- Sara E Berman
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA ; Neuroscience Training Program, University of Wisconsin - Madison, Madison, WI 53705, USA ; Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Xiao Wang
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Carol C Mitchell
- Department of Medicine, Cardiovascular Medicine Section, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Bornali Kundu
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Stephanie M Wilbrand
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Howard A Rowley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Sterling C Johnson
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI 53705, USA ; Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA ; Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin - Madison, Madison, WI 53705, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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Hanby MF, Al-Bachari S, Makin F, Vidyasagar R, Parkes LM, Emsley HCA. Structural and physiological MRI correlates of occult cerebrovascular disease in late-onset epilepsy. Neuroimage Clin 2015; 9:128-33. [PMID: 26413475 PMCID: PMC4556750 DOI: 10.1016/j.nicl.2015.07.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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] [Indexed: 11/28/2022]
Abstract
Late-onset epilepsy (LOE), with onset after 50 years of age, is often attributed to underlying occult cerebrovascular disease. LOE is associated with a three-fold increase in subsequent stroke risk, therefore it is important to improve our understanding of pathophysiology. In this exploratory study, we aimed to determine whether established structural magnetic resonance imaging markers and novel physiological imaging markers of occult cerebrovascular disease were more common in patients with LOE than age-matched controls. Sixteen patients with LOE (mean age ± SD: 67.6 ± 6.5 years) and 15 age-matched control subjects (mean age: 65.1 ± 3.9 years) underwent a 3 T MRI scan protocol. T1-weighted images and T2-weighted fluid attenuated inversion recovery (FLAIR) images were used to determine cortical grey matter volume and white matter hyperintensity (WMH) volume respectively, whilst multiple delay time arterial spin labelling (ASL) images were collected at rest and during a hypercapnic challenge. Cerebral blood flow (CBF) and arterial arrival time (AAT) were calculated from ASL data under both normocapnic and hypercapnic conditions. Cerebrovascular reactivity was also calculated for both CBF and AAT relative to the change in end-tidal CO2. Patients with LOE were found to have significantly lower cortical volume than control subjects (33.8 ± 3.8% of intracranial volume vs. 38.0 ± 5.5%, p = 0.02) and significantly higher WMH volume (1339 ± 1408 mm3 vs. 514 ± 481 mm3, p = 0.047). Baseline whole brain AAT was found to be significantly prolonged in patients with LOE in comparison to control subjects (1539 ± 129 ms vs. 1363 ± 167 ms, p = 0.005). Voxel-based analysis showed the significant prolongation of AAT to be predominantly distributed in the frontal and temporal lobes. Voxel-based morphometry showed the lower cortical volume to be localised primarily to temporal lobes. No significant differences in CBF or cerebrovascular reactivity were found between the two groups. Baseline whole brain AAT and cortical volume differences persisted upon further analysis to take account of differences in smoking history between patients and control subjects. These findings suggest that occult cerebrovascular disease is relevant to the pathophysiology of LOE. LOE patients were found to have increased WMHs and reduced GM volume on MRI imaging in comparison to HC. Baseline arterial arrival time was significantly longer in LOE patients than HC. Baseline cerebral blood flow did not differ between LOE patients and HC. Cerebrovascular reactivity did not differ between LOE patients and HC.
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Key Words
- AAT, arterial arrival time
- ASL, arterial spin labelling
- Arterial spin labelling
- CBF, cerebral blood flow
- CT, computerised tomography
- CVD, cerebrovascular disease
- CVR, cerebrovascular reactivity
- Cerebral blood flow
- Cerebrovascular disease
- EEG, electroencephalogram
- ETCO2, end-tidal CO2
- FLAIR, fluid attenuated inversion recovery image
- FWHM, full width half maximum
- GM, grey matter
- ICV, intracranial volume
- LOE, late-onset epilepsy
- Late-onset epilepsy
- MRI, magnetic resonance imaging
- MoCA, Montreal cognitive assessment
- SVD, small vessel disease
- Seizures
- VBA, voxel-based analysis
- VBM, voxel-based morphometry.
- Voxel-based morphometry
- WMH, white matter hyperintensity
- oCVD, occult cerebrovascular disease
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Affiliation(s)
- Martha F Hanby
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK ; Department of Neurology, Royal Preston Hospital, Preston, UK
| | - Sarah Al-Bachari
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Fadiyah Makin
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Rishma Vidyasagar
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Laura M Parkes
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Hedley C A Emsley
- Department of Neurology, Royal Preston Hospital, Preston, UK ; Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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Promjunyakul N, Lahna D, Kaye JA, Dodge HH, Erten-Lyons D, Rooney WD, Silbert LC. Characterizing the white matter hyperintensity penumbra with cerebral blood flow measures. Neuroimage Clin 2015; 8:224-9. [PMID: 26106546 PMCID: PMC4473817 DOI: 10.1016/j.nicl.2015.04.012] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [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: 03/05/2015] [Revised: 04/11/2015] [Accepted: 04/13/2015] [Indexed: 11/17/2022]
Abstract
Objective White matter hyperintensities (WMHs) are common with age, grow over time, and are associated with cognitive and motor impairments. Mechanisms underlying WMH growth are unclear. We aimed to determine the presence and extent of decreased normal appearing white matter (NAWM) cerebral blood flow (CBF) surrounding WMHs to identify ‘WM at risk’, or the WMH CBF penumbra. We aimed to further validate cross-sectional finding by determining whether the baseline WMH penumbra CBF predicts the development of new WMHs at follow-up. Methods Sixty-one cognitively intact elderly subjects received 3 T MPRAGE, FLAIR, and pulsed arterial spin labeling (PASL). Twenty-four subjects returned for follow-up MRI. The inter-scan interval was 18 months. A NAWM layer mask, comprised of fifteen layers, 1 mm thick each surrounding WMHs, was generated for periventricular (PVWMH) and deep (DWMH) WMHs. Mean CBF for each layer was computed. New WMH and persistent NAWM voxels for each penumbra layer were defined from follow-up MRI. Results CBF in the area surrounding WMHs was significantly lower than the total brain NAWM, extending approximately 12 mm from both the established PVWMH and DWMH. Voxels with new WMH at follow-up had significantly lower baseline CBF than voxels that maintained NAWM, suggesting that baseline CBF can predict the development of new WMHs over time. Conclusions A CBF penumbra exists surrounding WMHs, which is associated with future WMH expansion. ASL MRI can be used to monitor interventions to increase white matter blood flow for the prevention of further WM damage and its cognitive and motor consequences. We examined cerebral blood flow (CBF) surrounding white matter hyperintensity (WMH) lesions. We examined whether low baseline CBF is associated with WMH expansion over time. WMH CBF penumbra exists, extending ~12 mm from both periventricular and deep WMH lesions. Baseline CBF can predict the development of new WMHs over time. ASL MRI can be used to monitor interventions to increase white matter blood flow.
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Key Words
- Arterial spin labeling (ASL)
- CASL, continuous arterial spin labeling
- CBF, cerebral blood flow
- Cerebral blood flow (CBF) penumbra
- Cognitive aging
- DWMH, deep white matter hyperintensity
- M0, the initial ASL datasets
- NAWM L1, normal appearing white matter layer 1
- NAWM L15, normal appearing white matter layer 15
- NAWM, normal appearing white matter
- PASL, pulsed arterial spin labeling
- PCASL, pseudo-continuous arterial spin labeling
- PVWMH, periventricular white matter hyperintensity
- Vascular dementia
- WMH, white matter hyperintensity
- White matter hyperintensity (WMH)
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Affiliation(s)
- N Promjunyakul
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - D Lahna
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - J A Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA ; Department of Neurology, Veterans Affairs Medical Center, Portland, OR 97239, USA
| | - H H Dodge
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - D Erten-Lyons
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA ; Department of Neurology, Veterans Affairs Medical Center, Portland, OR 97239, USA
| | - W D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - L C Silbert
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA ; Department of Neurology, Veterans Affairs Medical Center, Portland, OR 97239, USA
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