scholarly journals A High Burden of Cerebral white Matter Lesion: Evidences from 9 Asian Cities

2020 ◽  
Author(s):  
Bonnie Yin Ka Lam ◽  
Brian Yiu ◽  
Encarnita Ampil ◽  
Christopher Li-Hsian Chen ◽  
Yustiani Dikot ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Cognitive Performance ◽  
Small Vessel Disease ◽  
White Matter Lesion ◽  
Large Population ◽  
Significant Risk ◽  
Cerebral White Matter ◽  
Age Related ◽  
Asian Cities

Abstract Background Age-related white matter lesion (WML) is considered a manifestation of sporadic cerebral small vessel disease and an important pathological substrate for dementia. Asia is notable for its large population with a looming dementia epidemic. Yet, the burden of WML and its associated risk factors across different Asian societies are unknown. Methods Subjects from 9 Asian cities (Bangkok, Bandung, Beijing, Bengaluru, Hong Kong, Kaohsiung, Manila, Seoul, and Singapore) were recruited (n = 5,701) and classified into i) stroke/transient ischemic attack (TIA), ii) Alzheimer’s disease (AD)/mild cognitive impairment (MCI), or iii) control groups. Data on vascular risk factors and cognitive performance were collected. The severity of WML was visually rated on MRI or CT. ResultsThe prevalence of moderate-to-severe WML was the highest in subjects with stroke/TIA (43.3 %). Bandang Indonesia showed the highest prevalence of WML, adjusted for age, sex, education and disease groups. Hypertension and hyperlipidemia were significant risk factors for WML, and WML was negatively associated with MMSE in all groups. ConclusionsWML is highly prevalent in Asia and is associated with increasing age, hypertension, hyperlipidemia and worse cognitive performance. Concerted efforts to prevent WML will alleviate the huge dementia burden in the rapidly aging Asian societies.

scholarly journals High burden of cerebral white matter lesion in 9 Asian cities

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bonnie Yin Ka Lam ◽  
Brian Yiu ◽  
Encarnita Ampil ◽  
Christopher Li-Hsian Chen ◽  
Yustiani Dikot ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Cognitive Performance ◽  
Small Vessel Disease ◽  
White Matter Lesion ◽  
Large Population ◽  
Significant Risk ◽  
Cerebral White Matter ◽  
Age Related ◽  
Asian Cities

AbstractAge-related white matter lesion (WML) is considered a manifestation of sporadic cerebral small vessel disease and an important pathological substrate for dementia. Asia is notable for its large population with a looming dementia epidemic. Yet, the burden of WML and its associated risk factors across different Asian societies are unknown. Subjects from 9 Asian cities (Bangkok, Bandung, Beijing, Bengaluru, Hong Kong, Kaohsiung, Manila, Seoul, and Singapore) were recruited (n = 5701) and classified into (i) stroke/transient ischemic attack (TIA), (ii) Alzheimer’s disease (AD)/mild cognitive impairment (MCI), or (iii) control groups. Data on vascular risk factors and cognitive performance were collected. The severity of WML was visually rated on MRI or CT. The prevalence of moderate-to-severe WML was the highest in subjects with stroke/TIA (43.3%). Bandung Indonesia showed the highest prevalence of WML, adjusted for age, sex, education, disease groups, and imaging modality. Hypertension and hyperlipidemia were significant risk factors for WML, and WML was negatively associated with MMSE in all groups. WML is highly prevalent in Asia and is associated with increasing age, hypertension, hyperlipidemia, and worse cognitive performance. Concerted efforts to prevent WML will alleviate the huge dementia burden in the rapidly aging Asian societies.

Abstract 151: Enlarged Perivascular Spaces in Lacunar Stroke Patients. The Secondary Prevention of Small Subcortical Stroked (SPS3) trial.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Hideki Ohba ◽  
Lesly Pearce ◽  
Gillian Potter ◽  
Oscar Benavente
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
White Matter ◽  
Small Vessel Disease ◽  
Large Cohort ◽  
Common Finding ◽  
Perivascular Spaces ◽  
Lacunar Stroke ◽  
Stroke Patients ◽  
Age Related

Introduction: Enlarge perivascular spaces (EPVS) are a common finding on MRI with little known about their aetiology or clinical significance. Associations of EPVS with white matter hyperintensities (WMH) and cognitive impairment have been reported. We assessed the prevalence of EPVS in the basal ganglia (BG) and centrum semiovale (CS) and associations with vascular risk factors, MRI abnormalities, and cognitive impairment in a large cohort of MRI documented lacunar stroke patients. Methods: All SPS3 participants enrolled in North America (N=1632) were included in the cohort. MRIs were obtained at the time of index stroke. We graded severity of EPVS on T2 in each of the right and left BG and CS as: <10, 11-20, or 20+. We assessed relationships between maximum (max) BG and CS scores and patient demographics, number of subcortical infarcts, WMH, and cognitive impairment using chi-square tests and ANOVA. Logistic regression was used to identify independent associations between max score in the BG or CS (<10 vs. 11+ points) and these factors. Results: Of the 1632 MRIs, 1172 had T2-imaging available. EPVS was symmetrical in right and left sides of BG and of CS so max score in each area were used for analyses. In 42% of BG and 69% of CS, the max number of unilateral EPVS was ≥11. Patients with more EPVS in the BG were older (mean 59 vs. 63 vs. 70 years, p < 0.001), had hypertension (75% vs. 84% vs. 86% p < 0.001), and lower eGFR (mean 83 vs. 80 vs. 74 ml/min/1.73m 2 , p = 0.006). More EPVS in the BG were associated with WMH severity as measured by Age Related White Matter Changes total score (median 3 vs. 6 vs. 8, p < 0.001). Patients with more EPVS in the BG more often had multiple infarcts (11% vs. 19% vs. 29%, p<0.001). All findings were similar in the CS. Age (OR 1.9 per each 10 years, 95% CI 1.7-2.1), history of hypertension (OR 1.7, 95% CI 1.2-2.3) and multiple infarcts (OR 2.4, 95% CI 1.7-3.4) were independently associated with a maximum unilateral EPVS score of 2+ in the BG. Mild cognitive impairment was not associated with EPVS in BG (p=0.3) or CS (p=0.5). Conclusions: In this well-defined large cohort of lacunar stroke patients, BG EPVS were associated with age, hypertension and multiple infarcts. These findings suggest that BG EPVS share similar risk factors with lacunar stroke and may be a marker for small vessel disease. Unexpectedly, EPVS were not associated with cognitive impairment.

scholarly journals Association of enlarged perivascular spaces and anticoagulant-related intracranial hemorrhage

Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2192-e2199 ◽  
Author(s):  
Jonathan G. Best ◽  
Carmen Barbato ◽  
Gareth Ambler ◽  
Houwei Du ◽  
Gargi Banerjee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
White Matter ◽  
Basal Ganglia ◽  
Intracranial Hemorrhage ◽  
Cox Regression ◽  
Significant Risk ◽  
Cerebral White Matter ◽  
Perivascular Spaces ◽  
Univariable Analysis

ObjectiveTo investigate whether enlarged perivascular spaces (PVS) within the basal ganglia or deep cerebral white matter are risk factors for intracranial hemorrhage in patients taking oral anticoagulants (OACs), independent of established clinical and radiologic risk factors, we conducted a post hoc analysis of Clinical Relevance of Microbleeds in Stroke (CROMIS-2) (atrial fibrillation [AF]), a prospective inception cohort study.MethodsPatients with atrial fibrillation and recent TIA or ischemic stroke underwent standardized MRI prior to starting OAC. We rated basal ganglia PVS (BGPVS) and centrum semiovale PVS (CSOPVS), cerebral microbleeds (CMBs), white matter hyperintensities, and lacunes. We dichotomized the PVS rating using a threshold of >10 PVS in the relevant region of either cerebral hemisphere. The primary outcome was symptomatic intracranial hemorrhage (sICH). We identified risk factors for sICH using Cox regression.ResultsA total of 1,386 participants with available clinical and imaging variables were followed up for a mean of 2.34 years; 14 sICH occurred (11 intracerebral). In univariable analysis, diabetes, CMB presence, lacune presence, and >10 BGPVS, but not CSOPVS, were associated with sICH. In a multivariable model incorporating all variables with significant associations in univariable analysis, >10 BGPVS (hazard ratio [HR] 8.96, 95% [CI] 2.41–33.4, p = 0.001) and diabetes (HR 3.91, 95% CI 1.34–11.4) remained significant risk factors for sICH.ConclusionEnlarged BGPVS might be a novel risk factor for OAC-related ICH. The strength of this association and potential use in predicting ICH in clinical practice should be investigated in larger cohorts.

scholarly journals Cerebral White Matter Hyperintensity as a Healthcare Quotient

2019 ◽  
Vol 8 (11) ◽  
pp. 1823 ◽  
Author(s):  
Kaechang Park ◽  
Kiyotaka Nemoto ◽  
Yoshinori Yamakawa ◽  
Fumio Yamashita ◽  
Keitaro Yoshida ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Linear Regression Analysis ◽  
Large Population ◽  
Multiple Linear Regression Analysis ◽  
White Matter Hyperintensity ◽  
Cerebral White Matter ◽  
Vascular Risk ◽  
Abnormal Lipid Metabolism ◽  
The Impact

To better understand the risk factors and optimal therapeutic strategies of cerebral white matter hyperintensity (WMH), we examined a large population of adults with and without various vascular risk factors (VRFs) or vascular risk conditions (VRCs), such as hypertension (HT), diabetes mellitus (DM), and dyslipidemia (DLP), including the comorbidities. We assessed two participant groups having no medical history of stroke or dementia that underwent brain checkup using magnetic resonance imaging (MRI): 5541 participants (2760 men, 2781 women) without VRCs and 1969 participants (1169 men, 800 women) who had received drug treatments for VRCs and the combination of comorbidities. For data analysis, we constructed WMH-brain healthcare quotient (WMH-BHQ) based on the percentile rank of WMH volume. This metric has an inverse relation to WMH. Multiple linear regression analysis of 5541 participants without VRCs revealed that age, systolic blood pressure (SBP), Brinkman index (BI), and female sex were significant factors lowering WMH-BHQ, whereas body mass index (BMI), male sex, fasting blood sugar, and triglyceride levels were increasing factors. The Kruskal–Wallis test and Dunn tests showed that WMH-BHQs significantly increased or decreased with BMI or SBP and with BI classification, respectively. Regarding the impact of impaired fasting glucose and abnormal lipid metabolism, there were almost no significant relationships. For 1969 participants who had HT, DM, and DLP, as well as their comorbidities, we found that DLP played a substantial role in increasing WMH-BHQ for some comorbidities, whereas the presence of HT and DM alone tended to decrease it. Cerebral WMH can be used as a healthcare quotient for quantitatively evaluating VRFs and VRCs and their comorbidities.

Risk Factors for Aphasia in Cerebral Small Vessel Diseases

2019 ◽  
Vol 16 (2) ◽  
pp. 107-114
Author(s):  
Jiawei Xin ◽  
Xuanyu Huang ◽  
Xiaodong Pan ◽  
Lin Lin ◽  
Mingyao Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Rating Scale ◽  
Small Vessel Disease ◽  
Density Lipoprotein ◽  
Small Vessel ◽  
Lipid Lowering ◽  
Pathophysiological Mechanism ◽  
Chinese Han ◽  
Age Related

Background: Lacunes and white matter hyperintensities (WMH) are two common findings seen on neuroimaging in patients with cerebral small vessel disease (cSVD). Clinically we observed that some patients with cSVD have aphasia through the language assessment scale. Our study aimed to explore the underlying risk factors for aphasia in cSVD patients. Methods: This study retrospectively analyzed 38 patients, with and without aphasia, aged 50 or over, Chinese Han population, diagnosed as cSVD with lacunes and/or WMH. We collected demographic characteristics and vascular risk factors. The severity of WMH was assessed by the age related white matter changes (ARWMC) rating scale. Results: Risk factors associated with aphasia were: lower education (p = 0.029), higher total cholesterol (TC) levels (p = 0.023), and higher low-density lipoprotein cholesterol (LDL-C) levels (p = 0.027). After controlling for age and sex, levels of TC (odds ratios, 1.96; 95% confidence interval, 1.06-3.62; p = 0.032) remained associated with aphasia independently. Conclusion: High level of TC was significantly associated with a higher risk of aphasia in clinically silent cSVD patients. Early interventions including lipid-lowering treatment, cranial magnetic resonance imaging (MRI) and ARWMC rating scale should be performed. Further studies are needed to explore proper methods of prevention and treatment for aphasia in clinically silent cSVD patients, in addition to understanding the pathophysiological mechanism.

scholarly journals Cerebral White Matter Integrity Mediates Adult Age Differences in Cognitive Performance

2009 ◽  
Vol 21 (2) ◽  
pp. 289-302 ◽  
Author(s):  
David J. Madden ◽  
Julia Spaniol ◽  
Matthew C. Costello ◽  
Barbara Bucur ◽  
Leonard E. White ◽  
...  
Keyword(s):  
White Matter ◽  
Task Performance ◽  
Cognitive Performance ◽  
Age Differences ◽  
Right Hemisphere ◽  
Community Dwelling ◽  
White Matter Integrity ◽  
Cerebral White Matter ◽  
Age Related

Previous research has established that age-related decline occurs in measures of cerebral white matter integrity, but the role of this decline in age-related cognitive changes is not clear. To conclude that white matter integrity has a mediating (causal) contribution, it is necessary to demonstrate that statistical control of the white matter–cognition relation reduces the magnitude of age–cognition relation. In this research, we tested the mediating role of white matter integrity, in the context of a task-switching paradigm involving word categorization. Participants were 20 healthy, community-dwelling older adults (60–85 years), and 20 younger adults (18–27 years). From diffusion tensor imaging tractography, we obtained fractional anisotropy (FA) as an index of white matter integrity in the genu and splenium of the corpus callosum and the superior longitudinal fasciculus (SLF). Mean FA values exhibited age-related decline consistent with a decrease in white matter integrity. From a model of reaction time distributions, we obtained independent estimates of the decisional and nondecisional (perceptual–motor) components of task performance. Age-related decline was evident in both components. Critically, age differences in task performance were mediated by FA in two regions: the central portion of the genu, and splenium–parietal fibers in the right hemisphere. This relation held only for the decisional component and was not evident in the nondecisional component. This result is the first demonstration that the integrity of specific white matter tracts is a mediator of age-related changes in cognitive performance.

Effect of the Interaction Between Hypertension and Cerebral White Matter Changes on the Progression of Alzheimer Disease

2018 ◽  
Vol 15 (14) ◽  
pp. 1354-1360 ◽  
Author(s):  
Ping-Song Chou ◽  
Yi-Hui Kao ◽  
Meng-Ni Wu ◽  
Mei-Chuan Chou ◽  
Chun-Hung Chen ◽  
...  
Keyword(s):  
White Matter ◽  
Alzheimer Disease ◽  
Rating Scale ◽  
Vital Role ◽  
Independent Effect ◽  
Cerebral White Matter ◽  
Clinical Dementia Rating ◽  
White Matter Changes ◽  
Age Related ◽  
The Mean

Background: Cerebrovascular pathologies and hypertension could play a vital role in Alzheimer disease (AD) progression. However, whether cerebrovascular pathologies and hypertension accelerate the AD progression through an independent or interaction effect is unknown. Objective: To investigate the effect of the interactions of cerebrovascular pathologies and hypertension on AD progression. Method: A retrospective longitudinal study was conducted to compare AD courses in patients with different severities of cerebral White Matter Changes (WMCs) in relation to hypertension. Annual comprehensive psychometrics were performed. WMCs were rated using a rating scale for Age-related WMCs (ARWMC). Results: In total, 278 patients with sporadic AD were enrolled in this study. The mean age of the patients was 76.6 ± 7.4 years, and 166 patients had hypertension. Among AD patients with hypertension, those with deterioration in clinical dementia rating-sum of box (CDR-SB) and CDR had significantly severe baseline ARWMC scales in total (CDR-SB: 5.8 vs. 3.6, adjusted P = 0.04; CDR: 6.4 vs. 4.4, adjusted P = 0.04) and frontal area (CDR-SB: 2.4 vs. 1.2, adjusted P = 0.01; CDR: 2.4 vs. 1.7, adjusted P < 0.01) compared with those with no deterioration in psychometrics after adjustment for confounders. By contrast, among AD patients without hypertension, no significant differences in ARWMC scales were observed between patients with and without deterioration. Conclusion: The effect of cerebrovascular pathologies on AD progression between those with and without hypertension might differ. An interaction but not independent effect of hypertension and WMCs on the progression of AD is possible.

scholarly journals Vascular lesions and functional limitations among older adults: does depression make a difference?

2014 ◽  
Vol 26 (9) ◽  
pp. 1501-1509 ◽  
Author(s):  
Celia F. Hybels ◽  
Carl F. Pieper ◽  
Lawrence R. Landerman ◽  
Martha E. Payne ◽  
David C. Steffens
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
White Matter ◽  
Functional Impairment ◽  
Functional Limitations ◽  
Late Life ◽  
Cognitive Status ◽  
Cerebral White Matter ◽  
Late Life Depression ◽  
Increased Risk

ABSTRACTBackground:The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment.Methods:The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging.Results:In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression.Conclusions:These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.

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