scholarly journals Decreased nocturnal heart rate variability and potentially related brain regions in arteriosclerotic cerebral small vessel disease

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Miaoyi Zhang ◽  
Huan Yu ◽  
Weijun Tang ◽  
Ding Ding ◽  
Jie Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sleep Disordered Breathing ◽  
Brain Volume ◽  
Small Vessel Disease ◽  
Three Dimensional ◽  
Brain Regions ◽  
Cerebral Small Vessel Disease ◽  
Sleep Period ◽  
Vessel Disease ◽  
Cerebrovascular Risk

Abstract Background To assess heart rate variability (HRV) among patients with arteriosclerotic cerebral small vessel disease (CSVD) by comparing with control subjects, and to determine whether HRV parameters were related to structural alterations in brain regions involved in autonomic regulation among CSVD patients. Methods We consecutively recruited subjects aged between 50 and 80 years who visited the Stroke Prevention Clinic of our hospital and have completed brain magnetic resonance imaging examination from September 1, 2018 to August 31, 2019. Polysomnography and synchronous analyses of HRV were then performed in all participants. Multivariable binary logistic regression was used to identify the relationship between HRV parameters and CSVD. Participants were invited to further undergo three-dimensional brain volume scan, and the voxel based morphometry (VBM) analysis was used to identify gray matter atrophy. Results Among 109 participants enrolled in this study, 63 were assigned to the arteriosclerotic CSVD group and 46 to the control group. Lower standard deviation of normal-to-normal intervals (SDNN, OR = 0.943, 95% CI 0.903 to 0.985, P = 0.009) and higher ratio of low to high frequency power (LF/HF, OR = 4.372, 95% CI 1.033 to 18.508, P = 0.045) during the sleep period were associated with CSVD, independent of traditional cerebrovascular risk factors and sleep disordered breathing. A number of 24 CSVD patients and 21 controls further underwent three-dimensional brain volume scan and VBM analysis. Based on VBM results, SDNN during the awake time (β = 0.544, 95% CI 0.211 to 0.877, P = 0.001) and the sleep period (β = 0.532, 95% CI 0.202 to 0.862, P = 0.001) were both positively related with gray matter volume within the right inferior frontal gyrus only among CSVD patients. Conclusions Decreased nocturnal HRV is associated with arteriosclerotic CSVD independent of traditional cerebrovascular risk factors and sleep disordered breathing. The structural atrophy of some brain regions associated with cardiac autonomic regulation sheds light on the potential relationship. Trial registration Trial registration number: ChiCTR1800017902. Date of registration: 20 Aug 2018.

scholarly journals Decreased Nocturnal Heart Rate Variability and Potentially Related Brain Regions In Arteriosclerotic Cerebral Small Vessel Disease

2021 ◽  
Author(s):  
Miaoyi Zhang ◽  
Huan Yu ◽  
Weijun Tang ◽  
Ding Ding ◽  
Jie Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Sleep Disordered Breathing ◽  
Small Vessel Disease ◽  
Brain Regions ◽  
Cerebral Small Vessel Disease ◽  
Sleep Period ◽  
Vessel Disease ◽  
Cerebrovascular Risk

Abstract Background To assess heart rate variability(HRV) among patients with arteriosclerotic cerebral small vessel disease (CSVD) by comparing with control subjects, and to determine whether HRV parameters were related to structural alterations in brain regions involved in autonomic regulation among CSVD patients. MethodsWe consecutively recruited subjects aged between 50 and 80 years who visited the Sleep Center of Huashan Hospital from September 1, 2018 to August 31, 2019. Brain magnetic resonance imaging(MRI) was scanned before enrollment. 63 patients were assigned to the arteriosclerotic CSVD group and 46 to the control group. Polysomnography and synchronous analyses of HRV were performed. Multivariable binary logistic regression was used to identify the relationship between HRV parameters and CSVD. A number of 24 CSVD patients and 21 control participants further underwent three-dimensional brain volume scan, and the voxel based morphometry (VBM) analysis was used to identify gray matter atrophy.ResultsLower standard deviation of normal-to-normal intervals(SDNN, OR=0.943, 95% CI 0.903 to 0.985, P=0.009) and higher ratio of low to high frequency power (LF/HF, OR=4.372, 95% CI 1.033 to 18.508, P=0.045) during the sleep period were associated with CSVD, independent of traditional cerebrovascular risk factors and sleep disordered breathing. Based on VBM results, SDNN during the awake time (b=0.544, 95% CI 0.211 to 0.877, P=0.001) and the sleep period(b=0.532, 95% CI 0.202 to 0.862, P=0.001) were both positively related with gray matter thickness within the right inferior frontal gyrus only among CSVD patients.ConclusionsDecreased nocturnal HRV may be associated with arteriosclerotic CSVD independent of traditional cerebrovascular risk factors and sleep disordered breathing. The structural atrophy of some brain regions associated with cardiac autonomic regulation sheds light on the potential relationship.Trial registration Trial registration number: ChiCTR1800017902.Date of registration: 2018-08-20

scholarly journals Association among Parkinsonism-related motor complaints, cerebral small vessel disease, and cerebrovascular risk factors in a community-dwelling population

2019 ◽  
Author(s):  
Yang Guo ◽  
Cai-hong Ji ◽  
Fei Han ◽  
Jiang-tao Zhang ◽  
Fei-fei Zhai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Small Vessel Disease ◽  
Univariate Analysis ◽  
The Elderly ◽  
Cerebral Small Vessel Disease ◽  
Community Dwelling ◽  
Small Vessel ◽  
Vessel Disease ◽  
Cerebrovascular Risk Factors ◽  
Cerebrovascular Risk

Abstract Background Parkinsonism-related motor complaints are commonly seen in the elderly. Our study aimed to investigate the association among Parkinsonism-related motor complaints, cerebral small vessel disease and cerebrovascular risk factors in a community-dwelling population in a Chinese rural area.Methods Individuals who were 50 years old or older, were independently living, were well-functioning, and had no history of ischemic or hemorrhagic stroke, were included. Brain magnetic resonance imaging (MRI), quantified motor function assessment, and questionnaire screening for Parkinsonism-related motor complaints were performed. Clinical data including cerebrovascular risk factors were collected. In univariate analysis, Chi-square test and student t-test were used to compare dichotomous variables and continuous variables, respectively, between individuals with or without motor complaints. In multivariate analysis, binary Logistic regression models were generated to determine risk factors for Parkinsonism-related motor complaints. General linear models were used to compare motor parameters between individuals with or without motor complaints. Results In the final analysis, 854 people were included. Individuals with motor complaints had a longer time for finger taping (6.2s v.s. 5.6s, p = 0.006), and a longer time for 3m-walking(4.0s v.s. 3.6s, p = 0.034) than did those without motor complaints. Hypertension was associated with motor complaints (odds ratio, 1.82; 95% confidence interval [CI], [1.21, 2.73]; p = 0.004). Age was not associated with motor complaints; none of the neuroimaging markers of cerebral small vessel disease was associated with motor complaints. Conclusion Hypertension is associated with Parkinsonism-related motor complaints. Better management of hypertension may prevent mobility limitation in the elderly. The questionnaire that we used for Parkinsonism is not suitable for screening small vessel disease in a community-dwelling population.

Abstract TP407: Effects of Remote Ischemic Conditioning on Cerebral Small Vessel Disease Outcomes

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yuan Wang ◽  
Haiqing Song ◽  
Kai Dong ◽  
Ran Meng ◽  
Shuying Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Flow Velocity ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Control Group ◽  
Vascular Risk ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Vessel Disease

Objective: To evaluate the preliminary efficacy of remote ischemic conditioning (RIC) on patients with cerebral small vessel disease (SVD). Methods: Thirty patients diagnosed with symptomatic SVD within 30 days of onset were enrolled in this prospectively randomized controlled study for 1 year. All patients received routine medical treatment including treating vascular risk factors according to the guideline. Patients in the experimental group (n=14) were administered 5 cycles consisting of ischemia followed by reperfusion for 5 minutes on bilateral upper limbs twice daily for 1 year. Those in the control group (n=16) underwent sham ischemia-reperfusion cycles. Primary outcome was the change of cognitive function measured by mini-mental state examination (MMSE) and montreal cognitive assessment scale (MoCA), and secondary outcomes were changes of plasma biomarkers, cerebral hemodynamic parameters measured by vascular ultrasound and brain lesions measured by MRI FLAIR both at baseline and at the end of 1 year visit. Results: Compared with patients in the control group, patients in the RIC group had higher flow velocity (FV), and lower pulsatility index (PI), but without statistical difference. Patients in the RIC group had improvement in visuospatial and executive abilities (3.86±1.03 vs. 4.43±0.85, p=0.026), reduced plasma triglyceride (1.60±0.74 vs. 1.25±0.38, p=0.019), low density lipoprotein (2.89±0.81 vs. 2.26±0.67, p=0.003) and homocysteine (15.66±10.11 vs. 13.66±9.80 p=0.017). Similarly in the RIC group, the diastolic flow velocity (DFV) of middle cerebral artery (MCA) (right: 33.93±7.67 vs. 36.93±6.12, p=0.032; left: 33.93±7.67 vs. 36.93± 6.12, p=0.032) and the mean flow velocity (MFV) of left MCA (35.00±5.04 vs. 39.50±5.59, p=0.003) increased, and the PI of MCA (right: 1.11±0.19 vs. 1.02±0.14 p=0.030; left: 1.10±0.22 vs. 0.99±0.14, p=0.037) decreased. Conclusion: RIC appears to be potentially effective for improving cognition, enhancing cerebral perfusion, and modifying vascular risk factors in SVD patients. Further studies focusing on long-term neurological outcomes and potential mechanisms underlying RIC on SVD patients are needed.

scholarly journals A population neuroscience approach to the study of cerebral small vessel disease in midlife and late life: an invited review

2018 ◽  
Vol 314 (6) ◽  
pp. H1117-H1136 ◽  
Author(s):  
Dana R. Jorgensen ◽  
C. Elizabeth Shaaban ◽  
Clayton A. Wiley ◽  
Peter J. Gianaros ◽  
Joseph Mettenburg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Small Vessel Disease ◽  
Later Life ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Cross Sectional ◽  
Vessel Disease ◽  
Age Related ◽  
Cerebral Microvasculature ◽  
Study Designs

Aging in later life engenders numerous changes to the cerebral microvasculature. Such changes can remain clinically silent but are associated with greater risk for negative health outcomes over time. Knowledge is limited about the pathogenesis, prevention, and treatment of potentially detrimental changes in the cerebral microvasculature that occur with advancing age. In this review, we summarize literature on aging of the cerebral microvasculature, and we propose a conceptual framework to fill existing research gaps and advance future work on this heterogeneous phenomenon. We propose that the major gaps in this area are attributable to an incomplete characterization of cerebrovascular pathology, the populations being studied, and the temporality of exposure to risk factors. Specifically, currently available measures of age-related cerebral microvasculature changes are indirect, primarily related to parenchymal damage rather than direct quantification of small vessel damage, limiting the understanding of cerebral small vessel disease (cSVD) itself. Moreover, studies seldom account for variability in the health-related conditions or interactions with risk factors, which are likely determinants of cSVD pathogenesis. Finally, study designs are predominantly cross-sectional and/or have relied on single time point measures, leaving no clear evidence of time trajectories of risk factors or of change in cerebral microvasculature. We argue that more resources should be invested in 1) developing methodological approaches and basic science models to better understand the pathogenic and etiological nature of age-related brain microvascular diseases and 2) implementing state-of-the-science population study designs that account for the temporal evolution of cerebral microvascular changes in diverse populations across the lifespan.

scholarly journals Cerebral small vessel disease, cardiovascular risk factors, and future walking speed in old age: a population-based cohort study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emerald G. Heiland ◽  
Anna-Karin Welmer ◽  
Grégoria Kalpouzos ◽  
Anna Laveskog ◽  
Rui Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Cognitive Function ◽  
Walking Speed ◽  
Small Vessel Disease ◽  
Population Based ◽  
Cerebral Small Vessel Disease ◽  
Vessel Disease

Abstract Background The purpose of this study was to examine the associations between combined and individual cerebral small vessel disease (cSVD) markers on future walking speed over 9 years; and to explore whether these associations varied by the presence of cardiovascular risk factors (CRFs). Methods This population-based cohort study included 331 adults, aged ≥60 years, without limitation in walking speed (≥0.8 m/s). At baseline, cSVD markers, including white matter hyperintensities (WMH), lacunes, and perivascular spaces (PVS), were assessed on magnetic resonance imaging. The modifiable CRFs (physical inactivity, heavy alcohol consumption, smoking, hypertension, high total cholesterol, diabetes, and overweight/obese) were combined into a score. The association between baseline cSVD markers and the decline in walking speed was examined using linear mixed-effects models, whereas Cox proportional hazards models were used to estimate the association with walking speed limitation (defined as < 0.8 m/s) over the follow-up. Results Over the follow-up period, 76 (23.0%) persons developed walking speed limitation. Participants in the highest tertile of the combined cSVD marker score had a hazard ratio (HR) of 3.78 (95% confidence interval [CI] 1.70-8.45) for walking speed limitation compared with people in the lowest score tertile, even after adjusting for socio-demographics, CRFs, cognitive function, and chronic conditions. When investigating the cSVD markers individually, having the highest burden of WMH was associated with a significantly faster decline in walking speed (β coefficient − 0.020; 95% CI -0.035-0.004) and a greater HR of walking speed limitation (HR 2.78; 95% CI 1.31-5.89) compared with having the lowest WMH burden. Similar results were obtained for the highest tertile of PVS (HR 2.13; 95% CI 1.04-4.36). Lacunes were associated with walking speed limitation, but only in men. Having ≥4 CRFs and high WMH volume simultaneously, showed a greater risk of walking speed limitation compared with having ≥4 CRFs and low WMH burden. CRFs did not modify the associations between lacunes or PVS and walking speed. Conclusions Combined cSVD markers strongly predict walking speed limitation in healthy older adults, independent of cognitive function, with WMH and PVS being the strongest contributors. Improving cardiovascular health may help to mitigate the negative effects of WMH on future walking speed.

scholarly journals Endothelial CXCL5 negatively regulates myelination and repair after white matter stroke

2019 ◽  
Author(s):  
Guanxi Xiao ◽  
Rosie Kumar ◽  
Yutaro Komuro ◽  
Jasmine Burguet ◽  
Visesha Kakarla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endothelial Cells ◽  
White Matter ◽  
Signaling Pathway ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Oligodendrocyte Progenitor ◽  
Vessel Disease ◽  
Cerebral Endothelial Cells

AbstractCerebral small vessel disease and resulting white matter pathologies are worsened by cardiovascular risk factors including obesity. The molecular changes in cerebral endothelial cells caused by chronic cerebrovascular risk factors remain unknown. We developed a novel approach for molecular profiling of chronically injured cerebral endothelial cells using cell-specific translating ribosome affinity purification (RiboTag) with RNA-seq in Tie2-Cre:RiboTag mice. We used this approach to identify the transcriptome of white matter endothelial cells after the onset of diet-induced obesity (DIO). DIO induces an IL-17B signaling pathway that acts on the cerebral endothelia through IL-17Rb to increase levels of both circulating CXCL5 and local endothelial expression of CXCL5 in both the DIO mouse model and in humans with imaging or pathologic evidence of cerebral small vessel disease. In the white matter, endothelial CXCL5 acts as a chemoattractant and promotes the association of oligodendrocyte progenitor cells (OPCs) with cerebral endothelia increasing vessel-associated OPC cell number and triggers OPC gene expression programs regulating migration and chemokine receptor activation. Targeted blockade of IL-17B with peripheral antibody administration reduced the population of vessel-associated OPCs by reducing endothelial CXCL5 expression. CXCL5-mediated sequestration of OPCs to white matter vasculature impairs OPC differentiation after a focal white matter ischemic lesion. DIO promotes a unique white matter endothelial-to-oligodendrocyte progenitor cell signaling pathway that compromises brain repair after stroke.

scholarly journals Risk factor profile of different clinical manifestations of cerebral small vessel disease - data from SHEF-CSVD Study

2017 ◽  
Author(s):  
J. Staszewski ◽  
E. Skrobowska ◽  
R. Piusińska-Macoch ◽  
B. Brodacki ◽  
A. Stępień
Keyword(s):  
Risk Factors ◽  
Uric Acid ◽  
Risk Factor ◽  
Cerebrovascular Disease ◽  
Fasting Glucose ◽  
Small Vessel Disease ◽  
Clinical Manifestations ◽  
Cerebral Small Vessel Disease ◽  
Vascular Risk ◽  
Vessel Disease

AbstractBACKGROUNDLittle is known of the mechanisms of cerebral small vessel disease (CSVD). Both atherosclerosis or non-atherosclerotic diffuse arteriopathy are involved.METHODSA single-center, prospective, case-control study was performed in consecutive patients with different CSVD manifestations. The study group consisted of 205 patients: 52 with lacunar stroke (LS), 20 with subcortical hemorrhagic stroke (HS), 50 with vascular dementia (VaD), 28 with vascular parkinsonism (VaP) and 55 controls (CG) free of cerebrovascular disease but with high vascular risk.RESULTSPatients with CSVD had significantly higher prevalence of vascular risk factors including hypertension, diabetes mellitus, polymetabolic syndrome and chronic kidney disease. Patients with CSVD had also significantly higher fasting blood glucose, homocysteine, fibrinogen, systolic blood pressure, IMT values and lower eGFR, albumin and HDL levels. After adjustment for age and sex, low eGFR, albumin and high levels of uric acid and fibrinogen were associated with all CSVD groups, elevated fasting glucose was related to LS and HS. In the multivariate analysiss, the independent predictors for CSVD were female sex, low albumin, high fibrinogen, fasting glucose and uric acid. Patients with LS had significantly higher IMT values comparing to other CSVD groups, patients with VaP had a trend towards higher homocysteine levels.CONCLUSIONRisk factor profile for CSVD as a whole differs from subjects with proatherogenic profile without history of cerebrovascular disease. Our results support the concept that CSVD is not homogeneous, and that unique risk factors profiles exist for different clinical manifestations of the disease.

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