scholarly journals Vascular brain pathology is more important than neurodegeneration in pathogenesis of pre-stroke cognitive impairment

2020 ◽  
Author(s):  
T Schellhorn ◽  
M Zucknick ◽  
T Askim ◽  
R Munthe-Kaas ◽  
H Ihle-Hansen ◽  
...  
Keyword(s):  
Gender Differences ◽  
Cognitive Impairment ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Small Vessel ◽  
Brain Pathology ◽  
Cerebrovascular Pathology ◽  
Vessel Disease ◽  
Increased Risk ◽  
Prospective Longitudinal

AbstractIntroductionTo better understand the development of post-stroke cognitive impairment,we explored the association between pre-stroke neuroimaging features and pre-stroke cognitive impairment and investigated possible gender differences. Few previous studies on this topic have been performed.MethodsIn this large prospective longitudinal multicenter brain-MRI cohort study, patients admitted to five stroke units at five different Norwegian hospitals were recruited as part of the Norwegian cognitive impairment after stroke study. Visual radiological assessment of small vessel disease and neurodegenerative changes were performed on brain MRI from 410 patients. Pre-stroke cognition was assessed using the Global Deterioration Scale.ResultsAt least one pathological marker was found in 68% of the patients. The mean age (SD) of the patients with no pathological changes other than the acute stroke, was 70 (± 12.9) and 75 (± 10.2) years for those with pathological scans (p ≤ 0.001). Men were more likely to have at least one pathological brain MRI finding, lacunes, or pathological medial temporal lobe atrophy. The highest percentage of patients with a pathological pre-stroke GDS were found in the “cerebrovascular pathology” group (37.5%) and in the “mixed pathology”-group (44%). In these groups, both men and women had an increased risk of impaired pre-stroke cognition.ConclusionThe majority of patients showed preexisting structural brain pathology. Cerebrovascular pathology was the dominating imaging finding associated with cognitive impairment, thus indicating that the pathogenesis of pre-stroke cognitive impairment might be driven more by small vessel disease (SVD) than neurodegenerative changes. Gender differences exists, with less pathology in women.

scholarly journals Increased risk of cognitive impairment and more severe brain lesions in hypertensive compared to non-hypertensive patients with cerebral small vessel disease

2018 ◽  
Vol 20 (9) ◽  
pp. 1260-1265 ◽  
Author(s):  
Aleksandra M. Pavlovic ◽  
Tatjana Pekmezovic ◽  
Jasna Zidverc Trajkovic ◽  
Gordana Tomic ◽  
Edita Cvitan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Brain Lesions ◽  
Small Vessel ◽  
Hypertensive Patients ◽  
Vessel Disease ◽  
Increased Risk

scholarly journals Cognitive impairment in patients with atrial fibrillation

2020 ◽  
Vol 4 (9) ◽  
pp. 578-583
Author(s):  
E.V. Mityaeva ◽  
◽  
P.R. Kamchatnov ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Alzheimer’S Disease ◽  
Cognitive Impairment ◽  
Tau Protein ◽  
Small Vessel Disease ◽  
Cardioembolic Stroke ◽  
Small Vessel ◽  
Vessel Disease ◽  
Increased Risk

Atrial fibrillation (AF) is an important medical and social problem due to its wide prevalence in the population and high risk of embolic complications leading to severe consequences. The article describes an association established between AF and an increased risk of cognitive impairment (CI). Cardioembolic stroke due to AF is a common cause of CI, however, there are other mechanisms for CI development. The article also examines the role of small vessel disease and asymptomatic cerebral infarction in the formation of CI in patients with AF. Adding that, it provides data on the AF role in the development of neurodegenerative process with the accumulation of amyloid and tau protein in the brain tissue. There is an increased risk of Alzheimer’s disease in patients with AF, although the causal relationship of these conditions requires clarification. Modern data concerning the role of neuroinflammation and genetic predisposition in the development of CI in AF were analyzed. The conclusion is made about the pathogenetic heterogeneity of higher cerebral functions disorders on the basis of the presented data on the CI pathogenetic mechanism in patients with AF and comorbid conditions. It was suggested that the optimal pathogenetic therapy can be chosen taking into account the known CI pathogenetic mechanisms. KEYWORDS: atrial fibrillation, cognitive impairment, dementia, Alzheimer’s disease, cardioembolic stroke, small vessel disease, neurodegeneration, amyloid, tau protein, pathogenesis. FOR CITATION: Mityaeva E.V., Kamchatnov P.R. Cognitive impairment in patients with atrial fibrillation. Russian Medical Inquiry. 2020;4(9):578–583. DOI: 10.32364/2587-6821-2020-4-9-578-583.

scholarly journals Nonfocal Transient Neurological Attacks Are Associated With Cerebral Small Vessel Disease

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3540-3544 ◽  
Author(s):  
Eline A. Oudeman ◽  
Jacoba P. Greving ◽  
Renske M. Van den Berg-Vos ◽  
Geert Jan Biessels ◽  
Esther E. Bron ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
White Matter ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease ◽  
Increased Risk

Background and Purpose— Nonfocal transient neurological attacks (TNAs), such as unsteadiness, bilateral weakness, or confusion, are associated with an increased risk of stroke and dementia. Cerebral ischemia plays a role in their pathogenesis, but the precise mechanisms are unknown. We hypothesized that cerebral small vessel disease is involved in the pathogenesis of TNAs and assessed the relation between TNAs and manifestations of cerebral small vessel disease on magnetic resonance imaging. Methods— We included participants from the HBC (Heart-Brain Connection) study. In this study, hemodynamic and cardiovascular contributions to cognitive impairment have been studied in patients with heart failure, carotid artery occlusion, or possible vascular cognitive impairment, as well as in a reference group. We excluded participants with a history of stroke or transient ischemic attacks. The occurrence of the following 8 TNAs was assessed with a standardized interview: unconsciousness, confusion, amnesia, unsteadiness, bilateral leg weakness, blurred vision, nonrotatory dizziness, and paresthesias. The occurrence of TNAs was related to the presence of lacunes or white matter hyperintensities (Fazekas score, ≥2; early confluent or confluent lesions) in logistic regression analysis, adjusted for age, sex, and hypertension. Results— Of 304 participants (60% men; mean age, 67±9 years), 63 participants (21%) experienced ≥1 TNAs. Lacunes and early confluent or confluent white matter hyperintensities were more common in participants with TNAs than in participants without TNAs (35% versus 20%; adjusted odds ratio, 2.32 [95% CI, 1.22–4.40] and 48% versus 27%; adjusted odds ratio, 2.65 [95% CI, 1.44–4.90], respectively). Conclusions— In our study, TNAs are associated with the presence of lacunes and early confluent or confluent white matter hyperintensities of presumed vascular origin, which indicates that cerebral small vessel disease might play a role in the pathogenesis of TNAs.

scholarly journals Broad phenotype of cysteine-altering NOTCH3 variants in UK Biobank

Neurology ◽  
2020 ◽  
Vol 95 (13) ◽  
pp. e1835-e1843 ◽  
Author(s):  
Julie W. Rutten ◽  
Remco J. Hack ◽  
Marco Duering ◽  
Gido Gravesteijn ◽  
Johannes G. Dauwerse ◽  
...  
Keyword(s):  
Small Vessel Disease ◽  
Brain Mri ◽  
Clinical Information ◽  
Community Dwelling ◽  
Small Vessel ◽  
White Matter Hyperintensity ◽  
Uk Biobank ◽  
Vessel Disease ◽  
Healthy Elderly ◽  
Increased Risk

ObjectiveTo determine the small vessel disease spectrum associated with cysteine-altering NOTCH3 variants in community-dwelling individuals by analyzing the clinical and neuroimaging features of UK Biobank participants harboring such variants.MethodsThe exome and genome sequencing datasets of the UK Biobank (n = 50,000) and cohorts of cognitively healthy elderly (n = 751) were queried for cysteine-altering NOTCH3 variants. Brain MRIs of individuals harboring such variants were scored according to Standards for Reporting Vascular Changes on Neuroimaging criteria, and clinical information was extracted with ICD-10 codes. Clinical and neuroimaging data were compared to age- and sex-matched UK Biobank controls and clinically diagnosed patients from the Dutch cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) registry.ResultsWe identified 108 individuals harboring a cysteine-altering NOTCH3 variant (2.2 of 1,000), of whom 75% have a variant that has previously been reported in CADASIL pedigrees. Almost all variants were located in 1 of the NOTCH3 protein epidermal growth factor–like repeat domains 7 to 34. White matter hyperintensity lesion load was higher in individuals with NOTCH3 variants than in controls (p = 0.006) but lower than in patients with CADASIL with the same variants (p < 0.001). Almost half of the 24 individuals with brain MRI had a Fazekas score of 0 or 1 up to age 70 years. There was no increased risk of stroke.ConclusionsAlthough community-dwelling individuals harboring a cysteine-altering NOTCH3 variant have a higher small vessel disease MRI burden than controls, almost half have no MRI abnormalities up to age 70 years. This shows that NOTCH3 cysteine altering variants are associated with an extremely broad phenotypic spectrum, ranging from CADASIL to nonpenetrance.

Abstract 13193: Association of Abnormal P-wave Indices With Brain MRI Infarcts: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jorge L Reyes ◽  
Faye L Norby ◽  
Wendy Wang ◽  
Romil Parikh ◽  
Niki C Oldenburg ◽  
...  
Keyword(s):  
Small Vessel Disease ◽  
Brain Mri ◽  
P Wave ◽  
Small Vessel ◽  
Silent Ischemia ◽  
Lacunar Infarcts ◽  
Vessel Disease ◽  
Increased Risk ◽  
Mri Scans ◽  
Multivariable Adjustment

Introduction: We recently reported that abnormal P-wave indices (PWI)—ECG markers of atrial cardiomyopathy (AC)—are associated with an increased risk of dementia, independent of atrial fibrillation (AF) and clinical ischemic stroke. The mechanisms, however, remain unclear, but may include silent ischemia. Hypothesis: Abnormal PWI are associated with higher prevalence of cortical infarcts on MRI, suggesting cardioembolism as a potential mechanism. Methods: ARIC-NCS participants (mean age, 72.2±5.3 years; 60% women; 29% black) who underwent 3T brain MRI scans in 2011-2013 were included. Abnormal PWI included P-wave terminal force in lead V1 [(PTFV1) defined as ≥4000 μV*ms] and P-wave duration [(PWD) defined as >120 ms], which were measured from standard 12-lead ECGs. Brain MRI outcomes included cortical infarcts, cerebral microbleeds (CMB), and markers of small vessel disease [white matter hyperintensities (WMH) and lacunar infarcts]. We used weighted multivariable logistic and linear regression analyses. Results: Of the 1,850 participants, 464 had abnormal PTFV1 and 415 had prolonged PWD. After multivariable adjustment including AF, abnormal PTFV1 and PWD were significantly associated with 26-44% increased odds of cortical and lacunar infarcts (Table) . Although PWD was associated with CMB in Model 1, the association was no longer significant after multivariable adjustment. Finally, abnormal PWIs were not associated with WMH after adjusting for stroke and AF (P >0.5). Conclusions: Abnormal PWI are associated with higher prevalence of cortical infarcts, suggesting cardioembolism with silent ischemia as a possible mechanism underlying the association of AC with dementia. More research is needed to evaluate other mechanisms such as cerebral small vessel disease.

scholarly journals Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes

2020 ◽  
Vol 5 (2) ◽  
pp. 128-137
Author(s):  
Huimin Chen ◽  
Yuesong Pan ◽  
Lixia Zong ◽  
Jing Jing ◽  
Xia Meng ◽  
...  
Keyword(s):  
Regression Models ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Arterial Stenosis ◽  
Small Vessel ◽  
Minor Stroke ◽  
Bleeding Events ◽  
Stroke Outcomes ◽  
Vessel Disease ◽  
Increased Risk

BackgroundThe effect of cerebral small vessel disease (CSVD) and intracranial arterial stenosis (ICAS) on stroke outcomes remains unclear.MethodsData of 1045 patients with minor stroke or transient ischaemic attack (TIA) were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale (mRS) scores using ordinal logistic regression models.ResultsAmong the 1045 patients, CSVD was present in 830 cases (79.4%) and ICAS in 460 (44.0%). Patients with >1 ICAS segment showed the highest risk of new strokes (HR 2.03, 95% CI 1.15 to 3.56, p=0.01). No association between CSVD and the occurrence of new strokes was found. The presence of severe CSVD (common OR (cOR) 2.01, 95% CI 1.40 to 2.89, p<0.001) and >1 ICAS segment (cOR 2.15, 95% CI 1.57 to 2.93, p<0.001) was associated with higher mRS scores. Severe CSVD (HR 10.70, 95% CI 1.16 to 99.04, p=0.04), but not ICAS, was associated with a higher risk of bleeding events. Six-point modified CSVD score improved the predictive power for bleeding events and disability.InterpretationCSVD is associated with more disability and bleeding events, and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months. CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes.Trial registration numberNCT00979589

Abstract P626: Periodontal Disease is Independently Associated With Cerebral Small Vessel Disease

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Forrest Lowe ◽  
Souvik Sen ◽  
Hamdi S Adam ◽  
Ryan Demmer ◽  
Bruce A Wasserman ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Periodontal Disease ◽  
Small Vessel Disease ◽  
Multinomial Logistic Regression ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
White Matter Hyperintensity ◽  
Periodontal Health ◽  
Vessel Disease ◽  
The Relationship

Background: Prior studies have shown the association between periodontal disease, lacunar strokes and cognitive impairment. Using the Atherosclerosis Risk in Communities (ARIC) cohort study we investigated the relationship between periodontal disease (PD) and the development of MRI verified small vessel disease. Methods: Using the ARIC database data we extracted data for 1143 (mean age 77 years, 76% white, 24% African-American and 45% male) participants assessed for PD (N=800) versus periodontal health (N=343). These participants were assessed for small vessel disease on 3T MRI as measured by the log of white matter hyperintensity volume (WMHV). WMHV were derived from a semiautomated segmentation of FLAIR images. Student t-test was then used to evaluate the relationship between small vessel disease as the log of WMHV in subjects with PD or periodontal health. Based on WMHV the patients were grouped into quartiles and the association of PD with WMHV were tested using the group in periodontal health and lowest quartile of WMHV as the reference groups. Multinomial logistic regression was used to compute crude and adjusted odds ratio (OR) for the higher quartiles of WMHV compared to the reference quartile. Results: There was a significant increase in the presence of small vessel disease measured as log WMHV in the PD cohort as compared to periodontal health cohort with p= 0.023 on Independent Sample t-est. Based on WMHV the subjects were grouped into quartiles 0-6.41, >6.41-11.56, >11.56-21.36 and >21.36 cu mm3). PD was associated with only the highest quartile of WMHV on univariate (crude OR 1.77, 95% CI 1.23-2.56) and multivariable (adjusted OR 1.61, 95% CI 1.06-2.44) analyses. The later was adjusted for age, race, gender, hypertension, diabetes and smoking. Conclusion: Based on this prospective cohort there is data to suggest that PD may be associated with cerebral small vessel disease. Maintaining proper dental health may decrease future risk for the associated lacunar strokes and vascular cognitive impairment.

Different cognitive profiles between mild cognitive impairment due to cerebral small vessel disease and mild cognitive impairment of Alzheimer’s disease origin

2009 ◽  
Vol 15 (6) ◽  
pp. 898-905 ◽  
Author(s):  
AIHONG ZHOU ◽  
JIANPING JIA
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Processing Speed ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Cognitive Domains ◽  
Vessel Disease

AbstractControversy surrounds the differences of the cognitive profile between mild cognitive impairment resulting from cerebral small vessel disease (MCI-SVD) and mild cognitive impairment associated with prodromal Alzheimer’s disease (MCI-AD). The aim of this study was to explore and compare the cognitive features of MCI-SVD and MCI-AD. MCI-SVD patients (n = 56), MCI-AD patients (n = 30), and normal control subjects (n = 80) were comprehensively evaluated with neuropsychological tests covering five cognitive domains. The performance was compared between groups. Tests that discriminated between MCI-SVD and MCI-AD were identified. Multiple cognitive domains were impaired in MCI-SVD group, while memory and executive function were mainly impaired in MCI-AD group. Compared with MCI-SVD, MCI-AD patients performed relatively worse on memory tasks, but better on processing speed measures. The AVLT Long Delay Free Recall, Digit Symbol Test, and Stroop Test Part A (performance time) in combination categorized 91.1% of MCI-SVD patients and 86.7% of MCI-AD patients correctly. Current study suggested a nonspecific neuropsychological profile for MCI-SVD and a more specific cognitive pattern in MCI-AD. MCI-AD patients demonstrated greater memory impairment with relatively preserved mental processing speed compared with MCI-SVD patients. Tests tapping these two domains might be potentially useful for differentiating MCI-SVD and MCI-AD patients. (JINS, 2009, 15, 898–905.)

Sign in / Sign up

Export Citation Format

Share Document