Age-Related Frontal Periventricular White Matter Hyperintensities and miR-92a-3p Are Associated with Early-Onset Post-Stroke Depression

Introduction: Age-related decline in gait and balance is a contributor to morbidity in the elderly. Subclinical cerebrovascular disease, seen on magnetic resonance imaging (MRI) as white matter hyperintensities (WMH) and silent brain infarcts (SBI), is associated with impaired mobility. Less is known about the association of WMH in specific brain regions and mobility impairment. We hypothesized that anterior WMH volume would be associated with lower scores on the Short Physical Performance Battery (SPPB), a well-validated mobility scale associated with falls and mortality in the elderly. Methods: Participants in the Northern Manhattan Study MRI cohort had the SPPB measured a median of 5 years after enrollment. The SPPB has three domains with a maximum total score of 12: gait speed, chair stands, standing balance. Volumetric distributions for WMH volume across 14 brain regions (brainstem, cerebellum, and bilateral frontal, occipital, temporal, and parietal lobes, and bilateral anterior and posterior periventricular white matter) were determined separately for each hemisphere by combining bimodal image intensity distribution and atlas based methods. Multi-variable linear regression was performed to examine the association between SBI and total and regional (frontal, parietal, occipital, temporal, anterior, posterior, and brainstem) head size-corrected WMH volumes, with the total SPPB score; models were adjusted for cardiovascular disease risk factors, osteo-arthritis, and grip strength. Results: Among 668 stroke-free participants with the SPPB available, mean age at the time of assessment was 74 ±9 years, 37% were male and 70% Hispanic; the mean SPPB score was 8.2 ± 2.9, interquartile range 7-10. Mean total WMHV was 0.55±0.75cc, mean anterior WMH volume 0.18±0.24cc, and 12% of participants had SBI. In multi-variable models, total WMHV was associated with a lower SPPB (beta = -0.3 per SD of logWMH, p=0.004), while SBI was not (beta= -0.12, p=0.7). For regional WMH volumes, only greater anterior periventricular WMHV was associated with SPPB (beta= -0.29 per SD, p=0.009). Conclusions: White matter hyperintensities, especially in the anterior cerebral regions, are associated with a lower SPPB. Prevention of subclinical cerebrovascular disease is a potential target to prevent physical aging in the elderly.

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White matter hyperintensity volume and early-onset post-stroke depression in Thai older patients

10.1101/2021.01.29.428768 ◽

2021 ◽

Author(s):

Chaichana Jaroonpipatkul ◽

Jaruwan Onwanna ◽

Chavit Tunvirachaisakul ◽

Nutchawan Jittapiromsak ◽

Yothin Rakvongthai ◽

...

Keyword(s):

White Matter ◽

Early Onset ◽

Older Patients ◽

Rating Scale ◽

Psychiatric Symptoms ◽

Anterior Segment ◽

White Matter Hyperintensity ◽

Madrs Score ◽

Post Stroke ◽

Post Stroke Depression

ABSTRACTObjectivePost-stroke depression (PSD) is one of the most frequent psychiatric symptoms after a stroke event. The role of white matter hyperintensities (WMHs) associated with PSD in older patients remains unclear. This study aimed to examine the volume and location of white matter microstructure abnormalities among older patients with early-onset PSD.MethodsOlder (≥55 years) patients with acute cerebral infarction and hospitalized in King Chulalongkorn Memorial Hospital’s stroke unit from October 2019 to September 2020 were recruited. Participants were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) within three months after the onset of stroke. All patients had MRI scans. The brain images were segmented into four regions via left/right, frontal/dorsal plains. Two WMHs volume detections (visual rating vs. semi-automated WMHs volumetric detection) were employed on the fluid-attenuated inversion recovery images (FLAIR) for each segment. The study then investigated the association between WMHs volume and MADRS score with regression analysis.ResultsThe study included twenty-nine patients with acute stroke. Total WMHs volume and segmented regions were not statistically associated with the MADRS score. However, there was a trend in different WHMs volume of the left anterior segment between depressed and non-depressed groups (t-test 2.058, p = 0.055). Further, demographic and clinical data showed no association with depressive symptoms.ConclusionThe volume of WHMs might not contribute to the development of early-onset PSD in older patients. This study showed a potential of a quantitative MRI analysis in clinical practice. Further investigation with a larger group of patients is needed.

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White matter hyperintensities in post-stroke depression: a case control study

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.2009.203141 ◽

2010 ◽

Vol 81 (12) ◽

pp. 1312-1315 ◽

Cited By ~ 23

Author(s):

W. K. Tang ◽

Y. K. Chen ◽

J. Y. Lu ◽

W. C. W. Chu ◽

V. C. T. Mok ◽

...

Keyword(s):

White Matter ◽

White Matter Hyperintensities ◽

Case Control Study ◽

Case Control ◽

Post Stroke ◽

Post Stroke Depression ◽

Control Study

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P.1.i.008 Association between white matter hyperintensities and post-stroke depression: a 1-year longitudinal study

European Neuropsychopharmacology ◽

10.1016/s0924-977x(14)70477-8 ◽

2014 ◽

Vol 24 ◽

pp. S301

Author(s):

K.Y. Bae ◽

J.M. Kim

Keyword(s):

Longitudinal Study ◽

White Matter ◽

White Matter Hyperintensities ◽

Post Stroke ◽

Post Stroke Depression

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Increase in periventricular white matter hyperintensities parallels decline in mental processing speed in a nondemented elderly population

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(08)70232-1 ◽

2007 ◽

Vol 2007 ◽

pp. 336-337

Author(s):

W.B. Gormley

Keyword(s):

White Matter ◽

Processing Speed ◽

Elderly Population ◽

White Matter Hyperintensities ◽

Periventricular White Matter

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Abstract P329: White Matter Score Does Not Predict Post-tPA Hemorrhage in Elderly Patients Evaluated Acutely via Telestroke

Stroke ◽

10.1161/str.52.suppl_1.p329 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Muhammad Bilal Tariq ◽

Shekhar Khanpara ◽

Eliana Bonfante Mejia ◽

Liang Zhu ◽

Christy T Ankrom ◽

...

Keyword(s):

White Matter ◽

Elderly Patients ◽

The Elderly ◽

Periventricular White Matter ◽

Severe Stroke ◽

Age Related ◽

Increased Risk ◽

Symptomatic Intracranial Hemorrhage ◽

Relationship Of ◽

Patient Presentation

Background: While tPA may be safe in the elderly, increasing age appears to augment risk of post-tPA symptomatic intracranial hemorrhage (sICH). Age-related white matter changes (ARWMC) are associated with increased sICH. Patients evaluated for acute ischemic stroke (AIS) via telestroke (TS) may not have access to MRI to allow incorporation of microbleeds in tPA decisions. We assessed if increased CT-based ARWMC was associated with increased sICH in elderly patients. Methods: Patients 80 years and older who received tPA for AIS at spoke hospitals were selected from our TS network registry from 9/2015 to 12/2018. TS spoke CT scans from patient presentation were reviewed by three of the authors for periventricular white matter (PWMC) and deep white matter (DWMC) changes. Total ARWMC score, based on the Fazekas score, was collected. Total ARWMC score was either mild (0-2), moderate (3-4), or severe (5-6). PWMC and DWMC were either mild (0-1) or moderate-severe (2-3). Logistic regression adjusted for age, sex, race, ethnicity, NIHSS and premorbid mRS was used to analyze relationship of ARWMC scores with sICH and patient-outcomes. Results: Of 241 patients, median age overall was 86 years (IQR 83-90), and 66% were female. The overall median ARWMC score was 3 (IQR 2-5). Regression analysis showed that more severe ARWMC scores did not lead to higher frequency of post-tPA ICH (moderate OR 0.57, CI 0.19-1.71; severe OR 1.32, CI 0.48-3.65) including sICH (moderate OR 0.78, CI 0.21-2.94; severe OR 2.09, CI 0.62-7.02). Similarly, severe PWMC and DWMC were not associated with increased risk of post-tPA ICH (PWMC OR 1.31, CI 0.51-3.38; DWMC OR 1.25, CI 0.52-3.01), including sICH (PWMC OR 1.61, CI 0.51-5.08; DWMC OR 1.81, CI 0.65-5.01). In our cohort, older patients had no difference in hemorrhage (ICH OR 0.93 CI 0.85-1.00: sICH OR 0.95 CI 0.86-1.04), and patients with less severe stroke were more likely to have hemorrhage (ICH OR 1.06 CI 1.02-1.10; sICH OR 1.08 CI 1.03-1.13). IRR among the CT scan readers was moderate (k=0.504). Conclusions: ARWMC scores were not associated with post-tPA ICH in the elderly. Our analysis lends support for the use of tPA despite severity of white matter disease. ARWMC should not be used to assist in tPA decision-making in elderly patients via telestroke.

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