scholarly journals Pre-stroke cognitive impairment is associated with vascular imaging pathology: a prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Till Schellhorn ◽  
Manuela Zucknick ◽  
Torunn Askim ◽  
Ragnhild Munthe-Kaas ◽  
Hege Ihle-Hansen ◽  
...  
Keyword(s):  
Sex Differences ◽  
Cognitive Impairment ◽  
Medial Temporal Lobe ◽  
Rating Scales ◽  
Brain Mri ◽  
Vascular Pathology ◽  
Stroke Severity ◽  
Brain Pathology ◽  
Global Deterioration Scale ◽  
Visual Rating

Abstract Background Chronic brain pathology and pre-stroke cognitive impairment (PCI) is predictive of post-stroke dementia. The aim of the current study was to measure pre-stroke neurodegenerative and vascular disease burden found on brain MRI and to assess the association between pre-stroke imaging pathology and PCI, whilst also looking for potential sex differences. Methods This prospective brain MRI cohort is part of the multicentre Norwegian cognitive impairment after stroke (Nor-COAST) study. Patients hospitalized with acute ischemic or hemorrhagic stroke were included from five participating stroke units. Visual rating scales were used to categorize baseline MRIs (N = 410) as vascular, neurodegenerative, mixed, or normal, based on the presence of pathological imaging findings. Pre-stroke cognition was assessed by interviews of patients or caregivers using the Global Deterioration Scale (GDS). Stroke severity was assessed with the National Institute of Health Stroke Scale (NIHSS). Univariate and multiple logistic regression analyses were performed to investigate the association between imaging markers, PCI, and sex. Results Patients’ (N = 410) mean (SD) age was 73.6 (±11) years; 182 (44%) participants were female, the mean (SD) NIHSS at admittance was 4.1 (±5). In 68% of the participants, at least one pathological imaging marker was found. Medial temporal lobe atrophy (MTA) was present in 30% of patients, white matter hyperintensities (WMH) in 38% of patients and lacunes in 35% of patients. PCI was found in 30% of the patients. PCI was associated with cerebrovascular pathology (OR 2.5; CI = 1.4 to 4.5, p = 0.001) and mixed pathology (OR 3.4; CI = 1.9 to 6.1, p = 0.001) but was not associated with neurodegeneration (OR 1.0; CI = 0.5 to 2.2; p = 0.973). Pathological MRI markers, including MTA and lacunes, were more prevalent among men, as was a history of clinical stroke prior to the index stroke. The OR of PCI for women was not significantly increased (OR 1.2; CI = 0.8 to 1.9; p = 0.3). Conclusions Pre-stroke chronic brain pathology is common in stroke patients, with a higher prevalence in men. Vascular pathology and mixed pathology are associated with PCI. There were no significant sex differences for the risk of PCI. Trial registration NCT02650531, date of registration: 08.01.2016.

scholarly journals A Comparative Analysis of Structural Brain MRI in the Diagnosis of Alzheimer’s Disease

2009 ◽  
Vol 21 (1-2) ◽  
pp. 13-19 ◽  
Author(s):  
Jason Appel ◽  
Elizabeth Potter ◽  
Qian Shen ◽  
Gustavo Pantol ◽  
Maria T. Greig ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Medial Temporal Lobe ◽  
Rating Scales ◽  
Brain Mri ◽  
Alzheimer’S Dementia ◽  
Alzheimer's Dementia ◽  
Increased Risk

Dementia is a debilitating and life-altering disease which leads to both memory impairment and decline of normal executive functioning. While causes of dementia are numerous and varied, the leading cause among patients 60 years and older is Alzheimer’s disease. The gold standard for Alzheimer’s diagnosis remains histological identification of amyloid plaques and neurofibrillary tangles within the medial temporal lobe, more specifically the entorhinal cortex and hippocampus. Although no definitive cure for Alzheimer's disease currently exists, there are treatments targeted at preserving cognition and memory while delaying continued loss of function. Alzheimer's disease exists along a spectrum of cognitive decline and is often preceded by Mild Cognitive Impairment (MCI). Patients with MCI demonstrate memory loss and cognitive impairment while still continuing normal activities of daily living, and are considered to be at increased risk for developing Alzheimer's Dementia. Identifying patients with prodromal states of Alzheimer's dementia such as MCI may allow initiation of appropriate treatment planning and delay of cognitive decline. Therefore, the need for a non-invasive early biomarker for the detection of Alzheimer's disease has never been greater. Multiple neuroimaging methods utilizing visual rating scales, volumetric measurements, and automated methods have been developed to identify, quantify, and track anatomic sequelae of Alzheimer’s Disease.

scholarly journals Combining visual rating scales of medial temporal lobe atrophy and posterior atrophy to identify amnestic mild cognitive impairment from cognitively normal older adults: evidence based on two datasets

2019 ◽  
Author(s):  
Can Sheng ◽  
Yu Sun ◽  
Min Wang ◽  
Xiaoni Wang ◽  
Yi Liu ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Medial Temporal Lobe ◽  
Rating Scales ◽  
Amnestic Mild Cognitive Impairment ◽  
Discriminative Power ◽  
Medial Temporal Lobe Atrophy ◽  
Cognitively Normal ◽  
Visual Rating ◽  
Lobe Atrophy ◽  
Posterior Atrophy

Abstract Background: Structural magnetic resonance imaging (MRI)-based visual rating scales are considered as the primary method for rapid and cost-effective evaluation of regional brain atrophy in patients with Alzheimer’s disease (AD) in routine clinical practice. Both medial temporal lobe atrophy (MTA) and posterior atrophy (PA) visual rating scales have been reported to be useful in AD diagnosis. However, very few existing studies have investigated the efficacy of combined MTA and PA for identification of amnestic mild cognitive impairment (aMCI) from cognitively normal elderly.Methods: This study included T1-weighted MRI images acquired inXuanwu Hospital of Capital Medical University, Beijing, China from two different cohorts. In the first cohort, we recruited 73 patients with aMCI and 48 group-matched cognitively normal controls for the training and validation. Visual assessments of MTA and PA, including left MTA, right MTA, mean MTA, left PA, right PA and mean PA, were carried out from each participant. Global gray matter (GM) volume and density was estimated using voxel-based morphometry analysis as the objective reference. Based on the receiver operating characteristic (ROC) analysis, we investigated the discriminative power of single visual rating scale and the combination of MTA and PA for successful classification between the two diagnostic groups, respectively, and then compared them to GM measures. The second cohort, consisted of 33 aMCI patients and 45 NCs, was used to verify the reliability of the discriminative power of visual assessments.Results: In the first cohort, visual rating scales of MTA and PA showed different potential to distinguish aMCI from controls. Moreover, the combination of MTA and PA exhibited the best discriminative power, with the AUC of 0.818 ± 0.041, which was similar to the diagnostic accuracy of GM volumetric measures (0.857 ± 0.034). The discriminative power was verified in the second cohort when combining MTA and PA visual rating scales, with the AUC of 0.824 ± 0.058.Conclusion: The combined visual rating scales of MTA and PA demonstrated practical diagnostic values for distinguishing aMCI patients from controls, suggesting its potential to serve as a convenient and reproducible method to assess the degree of atrophy in the clinical setting.

Combining Visual Rating Scales for Medial Temporal Lobe Atrophy and Posterior Atrophy to Identify Amnestic Mild Cognitive Impairment from Cognitively Normal Older Adults: Evidence Based on Two Cohorts

2020 ◽  
Vol 77 (1) ◽  
pp. 323-337
Author(s):  
Can Sheng ◽  
Yu Sun ◽  
Min Wang ◽  
Xiaoni Wang ◽  
Yi Liu ◽  
...  
Keyword(s):  
Medial Temporal Lobe ◽  
Rating Scales ◽  
Rating Scale ◽  
Discriminative Power ◽  
Medial Temporal Lobe Atrophy ◽  
Cognitively Normal ◽  
Visual Rating ◽  
Visual Rating Scale ◽  
Visual Assessments ◽  
Lobe Atrophy

Background: Visual rating scales for medial temporal lobe atrophy (MTA) and posterior atrophy (PA) have been reported to be useful for Alzheimer’s disease diagnosis in routine clinical practice. Objective: To investigate the efficacy of combined MTA and PA visual rating scales to discriminate amnestic mild cognitive impairment (aMCI) patients from healthy controls. Methods: This study included T1-weighted MRI images from two different cohorts. In the first cohort, we recruited 73 patients with aMCI and 48 group-matched cognitively normal controls for training and validation. Visual assessments of MTA and PA were carried out for each participant. Global gray matter volume and density were estimated using voxel-based morphometry analysis as the objective reference. We investigated the discriminative power of a single visual rating scale and the combination of the MTA and PA rating scales for identifying aMCI. The second cohort, consisting of 33 aMCI patients and 45 controls, was used to verify the reliability of the visual assessments. Results: Compared with the single visual rating scale, the combination of the MTA and PA exhibited the best discriminative power, with an AUC of 0.818±0.041, which was similar to the diagnostic accuracy of the gray matter volumetric measures. The discriminative power of the combined MTA and PA was verified in the second cohort (AUC 0.824±0.058). Conclusion: The combined MTA and PA rating scales demonstrated practical diagnostic value for distinguishing aMCI patients from controls, suggesting its potential to serve as a convenient and reproducible method to assess the degree of atrophy in clinical settings.

scholarly journals Medial temporal atrophy in preclinical dementia: visual and automated assessment during six year follow-up

2020 ◽  
Author(s):  
Gustav Mårtensson ◽  
Claes Håkansson ◽  
Joana B. Pereira ◽  
Sebastian Palmqvist ◽  
Oskar Hansson ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Medial Temporal Lobe ◽  
Rating Scales ◽  
Subjective Cognitive Decline ◽  
Strong Correlations ◽  
Rater Agreement ◽  
Morphological Marker ◽  
Visual Rating ◽  
Subcortical Volumes

AbstractMedial temporal lobe (MTL) atrophy is an important morphological marker of many dementias and is closely related to cognitive decline. In this study we aimed to characterize longitudinal progression of MTL atrophy in 93 individuals with subjective cognitive decline and mild cognitive impairment followed up over six years, and to assess if clinical rating scales are able to detect these changes. All MRI images were visually rated according to Scheltens’ scale of medial temporal atrophy (MTA) by two neuroradiologists and AVRA, a software for automated MTA ratings. The images were also segmented using FreeSurfer’s longitudinal pipeline in order to compare the MTA ratings to volumes of the hippocampi and inferior lateral ventricles. We found that MTL atrophy rates increased with CSF biomarker abnormality, used to define preclinical stages of Alzheimer’s Disease. Both AVRA’s and the radiologists’ MTA ratings showed a similar longitudinal trajectory as the subcortical volumes, suggesting that visual rating scales provide a valid alternative to automatic segmentations. While the MTA scores from each radiologist showed strong correlations to subcortical volumes, the inter-rater agreement was low. We conclude that the main limitation of quantifying MTL atrophy with visual ratings in clinics is the subjectiveness of the assessment.

scholarly journals The Contribution of Medial Temporal Lobe Atrophy and Vascular Pathology to Cognitive Impairment in Vascular Dementia

Stroke ◽  
2007 ◽  
Vol 38 (12) ◽  
pp. 3182-3185 ◽  
Author(s):  
António J. Bastos-Leite ◽  
Wiesje M. van der Flier ◽  
Elisabeth C.W. van Straaten ◽  
Salka S. Staekenborg ◽  
Philip Scheltens ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Vascular Dementia ◽  
Temporal Lobe ◽  
Medial Temporal Lobe ◽  
Vascular Pathology ◽  
Medial Temporal Lobe Atrophy ◽  
Lobe Atrophy

Activation-Induced Rigidity in Neurologically and Cognitively Healthy Individuals Aged 18–90 Years: A Cross-Sectional Study

2021 ◽  
pp. 1-10
Author(s):  
Cecilia Camarda ◽  
Paola Torelli ◽  
Carmela Pipia ◽  
Iacopo Bataglini ◽  
Gianluca Sottile ◽  
...  
Keyword(s):  
Rating Scales ◽  
Oldest Old ◽  
Brain Mri ◽  
Cross Sectional Study ◽  
Clinical Feature ◽  
Prodromal Phase ◽  
Cross Sectional ◽  
Caudate Nuclei ◽  
Visual Rating ◽  
The One

Background: Rigidity is a key clinical feature of Parkinson’s disease (PD), but in a very early phase of the disease, it may be absent and can be enhanced through active movements of the arm contralateral to the one being tested. Objective: To evaluate in a large cohort of neurologically and cognitively healthy (NCH) subjects aged 18–90 years if activation-induced rigidity (AR) is present in all age classes, and if there are biological differences between subjects showing AR (AR+) and not showing AR (AR-). Methods: 2,228 NCH subjects categorized as young adult (18–44 years), adult (45–64 years), elderly (65–74 years), and old/oldest-old (75–90 years) were included in the analysis, and underwent brain MRI. White matter hyperintensities were assessed through two visual rating scales. Lacunes were also rated. Atrophy of the caudate nuclei and ventricular enlargement were assessed through the bicaudate ratio and the lateral ventricles to brain ratio. To elicit AR, the Froment’s maneuver (FM) and the instructions of the UPDRS-ME were used. Results: Among the sample, 1,689 (75.81%) subjects showed AR, of which 1,270 (57.00%) subjects showed AR by using FM, and 419 (18.81%) showed AR by using UPDRS-ME instructions. The latter subjects also showed AR by using FM. The number of AR+ subjects significantly increased with increasing age, regardless of the activation maneuver used. In each age class, the number of AR+ subjects was significantly higher by using the FM than the UPDRS-ME instructions. Conclusion: Our findings suggest that AR is likely to be one of the signs of the prodromal phase of PD.

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