Carmen Arteaga , Yajun Cheng , Una Clancy , Razan Muradi , Maria C Valdes-Hernandez , Stewart Wiseman , Michael Stringer , Michael J Thrippleton , Charlene Hamid , Francesca M Chappell , Angela CC Jochems , Daniela Jaime , Will Hewins , Rachel Penman , Rosalind Brown , Gayle Barclay , Dominic Job , Fergus N Doubal , Joanna M Wardlaw
{"title":"Can smaller lacunes derived from recent small subcortical infarcts play a role in cognition at one- year after mild stroke?","authors":"Carmen Arteaga , Yajun Cheng , Una Clancy , Razan Muradi , Maria C Valdes-Hernandez , Stewart Wiseman , Michael Stringer , Michael J Thrippleton , Charlene Hamid , Francesca M Chappell , Angela CC Jochems , Daniela Jaime , Will Hewins , Rachel Penman , Rosalind Brown , Gayle Barclay , Dominic Job , Fergus N Doubal , Joanna M Wardlaw","doi":"10.1016/j.cccb.2024.100249","DOIUrl":"10.1016/j.cccb.2024.100249","url":null,"abstract":"<div><h3>Introduction</h3><p>Recent small subcortical infarcts (RSSI) may evolve into lacunes (cavities) smaller than 3mm or even disappear. The 3mm size cut-off used in guidelines might underestimate SVD burden. We hypothesised that participants with smaller (<3mm) lacunes have better cognitive outcomes at one-year follow-up than those with larger lacunes. We also aimed to determine rates of development of lacunes <3mm.</p></div><div><h3>Methods</h3><p>We recruited participants from two prospective stroke cohorts (MSS2 and MSS3) within 3-months after mild stroke. We included participants with MRI-confirmed RSSI and at least two MRI scans during the first one-year follow-up. We assessed for lesion change by visual assessment on T2- FLAIR (blinded). We recorded demographics, vascular risk factors, SVD burden, and clinical outcomes (NIHSS, modified Rankin score [mRS], Montreal Cognitive Assessment score [MoCA]), at baseline and one-year. We report maximum axial diameters (max-ax, mm) for RSSI and lacunes (continuous and dichotomised at < /≥3mm). We used regression analysis for associations between final lacune size/appearance and outcomes at one-year, adjusting for baseline demographics, VRF, and clinical scores.</p></div><div><h3>Results</h3><p>We included 198 participants; mean age 64 years (SD 11.1); 33% female. At one-year, 53/184 (26.8%) RSSI evolved into lacunes <3mm and 105/184 in to lacunes over 3mm (Table.1) Participants with lacunes <3mm had higher MoCA (MoCA<26; RR=0.57 [95%CI 0.33, 0.97]; vs 1.35 [1.05-1.75] for larger lacunes; p=0.03) and lower mRS (mRS 0-1; RR=1.79[1.11,2.91] vs 0.72[0.58-0.89]; p=.009). The end-stage lacune size correlated with RSSI max-ax diameter at baseline (r[df1]=[0.73],p<.001); there were no associations with demographics, VRF or SVD burden. At one-year, 47/143 (23.7%) participants had MoCA<26, and we investigated the effects of age, NIHSS, NART, RSSI max-ax diameter, SVD burden and MoCA at baseline and end-stage lacune max-axial diameter in this group. MoCA at baseline was a significant predictor for cognition at one-year (β=0.586, SE=0.90 [95%CI: 0.41, 0.76], p<.001). MoCA scores were lower in those with larger end-stage lacunes (β=-1.950, SE=0.70 [95%CI: 0.04, 0.56], p=0.005).</p></div><div><h3>Discussion</h3><p>Larger end-stage lacune diameters are associated with worse cognitive outcomes at one-year after mild stroke. Careful cognitive and lesion assessment of patients at diagnosis may help determine cognitive trajectories in patients with mild stroke.</p></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"6 ","pages":"Article 100249"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666245024000503/pdfft?md5=70c3842afb7358b15211d887dfc18c09&pid=1-s2.0-S2666245024000503-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline Robert , Lieng-Hsi Ling , Eugene Tan , Narayanaswamy Venketasubramanian , Shir Lynn Lim , Lingli Gong , Josephine Berboso , Arthur Mark Richards , Christopher Chen , Chuen Seng Tan , Saima Hilal
{"title":"The relative contributions of aortic and carotid artery stiffness to CeVD and cognition","authors":"Caroline Robert , Lieng-Hsi Ling , Eugene Tan , Narayanaswamy Venketasubramanian , Shir Lynn Lim , Lingli Gong , Josephine Berboso , Arthur Mark Richards , Christopher Chen , Chuen Seng Tan , Saima Hilal","doi":"10.1016/j.cccb.2024.100269","DOIUrl":"10.1016/j.cccb.2024.100269","url":null,"abstract":"<div><h3>Introduction</h3><p>The relative contributions of aortic and carotid artery stiffness on cognitive impairment and dementia remain unknown. We examined the associations of aortic and carotid artery stiffness with cerebrovascular disease markers, cognition, and dementia subtypes in a memory clinic cohort.</p></div><div><h3>Methods</h3><p>272 participants underwent applanation tonometry, carotid ultrasonography, 3T brain MRI, and neuropsychological assessment. Aortic stiffness parameters (carotid-femoral pulse wave velocity, aortic augmentation index, and aortic pulse pressure) were obtained with applanation tonometry whilst carotid artery stiffness parameters (β-index, pressure-strain elastic modulus, and pulse- wave velocity-β) were assessed by carotid ultrasonography, from which composite scores for aortic and carotid artery stiffness were calculated. Brain magnetic resonance images were graded for cerebrovascular disease markers, including white matter hyperintensities (WMH), lacunes, cerebral microbleeds, cortical infarcts, and stenosis. Cognition was assessed by the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the National Institute of Neurological Disorders and Stroke–Canadian Stroke Network harmonization battery in order to classify participants as having no cognitive impairment, cognitive impairment no dementia, or dementia subtyped as Alzheimer disease and vascular dementia.</p></div><div><h3>Results</h3><p>After considering both aortic and carotid artery stiffness in the same regression models, carotid artery stiffness remained independently and significantly associated with WMH (β=0.78, p<0.001), cortical infarcts (odds ratio [OR], 1.05, p=0.003), vascular dementia (OR, 1.10, p=0.017), MMSE (β=-0.89, p=0.013), global cognition (β=-0.33, p=0.017), and visuomotor speed (β=-0.19, p=0.004). Although aortic stiffness was associated with lacunes (OR, 1.09, p=0.035), and cortical infarcts (OR, 1.063, p=0.016), these associations became non-significant after adjusting for carotid artery stiffness.</p></div><div><h3>Discussion</h3><p>We found that compared with aortic stiffness, carotid artery stiffness had more robust associations with markers of cerebrovascular disease, vascular dementia, and cognitive function in memory clinic patients. Our study suggests that carotid artery stiffness may have a more salient effect on the brain.</p></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"6 ","pages":"Article 100269"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666245024000709/pdfft?md5=9d31fee77818a94c3565794c15fecbe1&pid=1-s2.0-S2666245024000709-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shanna L. Burke , Adrienne Grudzien , Tan Li , Marlou Abril , Wupeng Yin , Tahirah A. Tyrell , Christopher P. Barnes , Kevin Hanson , Steven T. DeKosky
{"title":"Examining the relationship between anxiety and regional brain volumes in the National Alzheimer's Coordinating Center uniform, imaging, and biomarker datasets","authors":"Shanna L. Burke , Adrienne Grudzien , Tan Li , Marlou Abril , Wupeng Yin , Tahirah A. Tyrell , Christopher P. Barnes , Kevin Hanson , Steven T. DeKosky","doi":"10.1016/j.cccb.2024.100201","DOIUrl":"10.1016/j.cccb.2024.100201","url":null,"abstract":"<div><p>Anxiety has been associated with a greater risk of Alzheimer's disease (AD). Existing research has identified structural differences in regional brain tissue in participants with anxiety, but results have been inconsistent. We sought to determine the association between anxiety and regional brain volumes, and the moderation effect of APOE ε4. Using data from participants in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set, with complete imaging (MRI) and biomarker data (<em>n</em> = 1533), multiple linear regression estimated the adjusted effect of anxiety on 30 structural MRI regions. The moderation effect of APOE ε4 on the relation between structural MRI regions and anxiety was assessed as was the moderation effect of cognitive status. False discovery rate was used to adjust for multiple comparisons. After controlling for intracranial volume, age, sex, years of education, race, Hispanic ethnicity, and cognitive status, seven MRI regions demonstrated lower volumes among participants with anxiety: total cerebrum gray matter volume, right hippocampus volume, hippocampal volume (total), right and left frontal lobe cortical gray matter volume, and right and total temporal lobe cortical gray matter volume. Findings suggest that anxiety is associated with significant atrophy in multiple brain regions, with corresponding ventricular enlargement. Future research should investigate if anxiety-related changes to brain morphology contribute to greater AD risk.</p></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"6 ","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666245024000023/pdfft?md5=b45a484addc552a8982c66abab689e66&pid=1-s2.0-S2666245024000023-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139638032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Cova , F. Mele , A. Nicotra , G. Maestri , V. Cucumo , S. Pomati , E. Salvadori , L. Pantoni
{"title":"The Luigi Sacco Hospital VAS-COG stroke care pathway: A five-year experience","authors":"I. Cova , F. Mele , A. Nicotra , G. Maestri , V. Cucumo , S. Pomati , E. Salvadori , L. Pantoni","doi":"10.1016/j.cccb.2024.100210","DOIUrl":"https://doi.org/10.1016/j.cccb.2024.100210","url":null,"abstract":"<div><h3>Background</h3><p>Psycho-cognitive consequences are a frequent cause of disability in stroke survivors but are often underdiagnosed also because of lack of services dedicated to these aspects. We started assessing systematically cognitive and behavioral functions in acute stroke patients and to follow them up. Here, we report a retrospective analysis of the organization of the Sacco VAS-COG stroke care pathway and the refinements implemented during 5 years of activity.</p></div><div><h3>Methods</h3><p>The protocol includes baseline collection of clinical history, general and neurologic examinations, functional, neuropsychological, and neuroimaging assessment. At follow-up, a diagnosis of cognitive decline was made based on best clinical judgment in the first period (January 2018 to May 2019, namely VAS-COG protocol 1.0) and then based on an extensive neuropsychological battery (May 2019 to January 2023, namely VASCOG protocol 2.0); psychiatric and behavioral disturbances are investigated through suitable scales.</p></div><div><h3>Results</h3><p>From January 2018 to December 2022, 834 patients (mean age 76±13.6 years; 46.6 % females) with acute cerebrovascular events were admitted to the stroke unit, mostly (80 %) for ischemic strokes. Pre-event cognitive impairment was not assessable in 78 patients (9.3 %) because no reliable informant was present and was reported in 327/756 (43 %) patients. During follow-up, post-stroke cognitive impairment was detected in 124/217 (57.1 %) patients in VAS-COG protocol 1.0 and in 137/201(68.2 %) patients in VAS-COG protocol 2.0, while 95/218 (43.2 %) patients were found to be depressed and patients presented on average 2.5 neuropsychiatric symptoms on Neuropsychiatric Inventory-questionnaire.</p></div><div><h3>Conclusions</h3><p>The VAS-COG stroke care pathway represents a model for patients and for their families.</p></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"6 ","pages":"Article 100210"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666245024000114/pdfft?md5=41cc527ff4202caedc3a750228de0529&pid=1-s2.0-S2666245024000114-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139709154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Georgina Boston , Dan Jobson , Toshiki Mizuno , Masafumi Ihara , Raj N Kalaria
{"title":"Most common NOTCH3 mutations causing CADASIL or CADASIL-like cerebral small vessel disease: A systematic review","authors":"Georgina Boston , Dan Jobson , Toshiki Mizuno , Masafumi Ihara , Raj N Kalaria","doi":"10.1016/j.cccb.2024.100227","DOIUrl":"10.1016/j.cccb.2024.100227","url":null,"abstract":"<div><p>Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a monogenic disorder caused by mutations in the <em>NOTCH3</em> gene. The main aim of our survey was to determine if there is an association between phenotypes and genotypes across the most common <em>NOTCH3</em> mutations found in CADASIL patients. We systematically searched clinical studies and genomic databases from 1996 to 2023 to first identify the most common mutations responsible for CADASIL. We found the six most common <em>NOTCH3</em> missense mutations globally were the p.R75P, p.R133C, p.R141C, p.R169C, p.R182C, and p.R544C, of which p.R133C was described to occur most often. Focusing on studies with comprehensive clinical records, our analysis further suggested that the p.R75P, p.R141C, p.R182C and p.R544C genotypes were highly congruent with the presence of white matter hyperintensities on magnetic resonance imaging (MRI), which was the most common phenotypic characteristic across all four mutations. We found the p.R141C mutation was associated with increased severity of disease. We also found the average age of onset in p.R544C carriers was more than a decade later compared to the p.R141C carriers. However, statistical analysis showed there were no overall differences between the phenotypic characteristics of the two common mutations, p.R141C and p.R544C. Geographically, China and Japan were the only two countries to report all the four common mutations vis a vis p.R75P, p.R141C, p.R182C and p.R544C. There is a possibility that this is due to a combination of a founder effect, but there also could be sampling biases.</p></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"6 ","pages":"Article 100227"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266624502400028X/pdfft?md5=7475787c1e2fecacb48a79d30a198f5f&pid=1-s2.0-S266624502400028X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141275566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bruno Miguel de Brito Robalo , Geert Jan Biessels , Christopher Chen , Anna Dewenter , Marco Duering , Saima Hilal , Huiberdina L. Koek , Anna Kopczak , Bonnie Lam , Alexander Leemans , Vincent Mok , Laurien P. Onkenhout , Hilde van den Brink , Alberto de Luca
{"title":"DIFFUSION MRI HARMONIZATION ENABLES JOINT-ANALYSIS OF MULTICENTRE DATA OF PATIENTS WITH CEREBRAL SMALL VESSEL DISEASE","authors":"Bruno Miguel de Brito Robalo , Geert Jan Biessels , Christopher Chen , Anna Dewenter , Marco Duering , Saima Hilal , Huiberdina L. Koek , Anna Kopczak , Bonnie Lam , Alexander Leemans , Vincent Mok , Laurien P. Onkenhout , Hilde van den Brink , Alberto de Luca","doi":"10.1016/j.cccb.2022.100104","DOIUrl":"https://doi.org/10.1016/j.cccb.2022.100104","url":null,"abstract":"","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"6 ","pages":"Article 100104"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666245022000691/pdfft?md5=3ebcf8cd045d877a161ff6efbf34dc49&pid=1-s2.0-S2666245022000691-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Veerle van Gils , Willemijn J. Jansen , Domantė Kučikienė , Ana Sofia Costa , Jörg B. Schulz , Frans Verhey , Kathrin Reetz , Stephanie J.B. Vos
{"title":"THE IMPACT OF ALZHEIMER BIOMARKERS AND VASCULAR FACTORS ON COGNITIVE DECLINE IN MEMORY CLINIC PATIENTS","authors":"Veerle van Gils , Willemijn J. Jansen , Domantė Kučikienė , Ana Sofia Costa , Jörg B. Schulz , Frans Verhey , Kathrin Reetz , Stephanie J.B. Vos","doi":"10.1016/j.cccb.2022.100051","DOIUrl":"https://doi.org/10.1016/j.cccb.2022.100051","url":null,"abstract":"","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"6 ","pages":"Article 100051"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666245022000162/pdfft?md5=592afaa61ea23ee723a33474d08cf2c7&pid=1-s2.0-S2666245022000162-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nunki Puspita Utomo, Rizaldy Taslim Pinzon, Patrick Kurniawan Latumahina, Kadex Reisya Sita Damayanti
{"title":"Astaxanthin and improvement of dementia: A systematic review of current clinical trials","authors":"Nunki Puspita Utomo, Rizaldy Taslim Pinzon, Patrick Kurniawan Latumahina, Kadex Reisya Sita Damayanti","doi":"10.1016/j.cccb.2024.100226","DOIUrl":"https://doi.org/10.1016/j.cccb.2024.100226","url":null,"abstract":"<div><p>Worldwide, the incidence of neurodegenerative diseases especially dementia is steadily increasing due to the aging population. Abundant research emerges on the probability of combating or preventing the degeneration process, with the most established one being to tackle the existence of oxidative stress and free radicals production due to their nature of aggravating dementia. Astaxanthin, a marine carotenoid, was proven to be a protective agent of cerebral ischemia through many animal model clinical trials. This review summarizes the evidence of Astaxanthin's benefits for cognitive function across clinical trials done in older age. The results are of interest as its supplementation does not exhibit unwanted issues on the consumer based on physical and laboratory examinations. Despite not being supported statistically, however, subjective and objective cognitive amelioration were reported according to the majority of this review's trial subjects. Although there is no clear and direct mechanism for cognitive improvement by Astaxanthin activity in the body systems, the encouragement of Astaxanthin supplementation should be considered as the elderly with dementia may highly benefit from the improved cognitive function.</p></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"7 ","pages":"Article 100226"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666245024000278/pdfft?md5=5b400399b52121d9ff200c5ef1cda3a9&pid=1-s2.0-S2666245024000278-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141479314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}