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Kim HJ, Jang H, Kim HJ, Na DL, Yoon JH. Kinematic characteristics in patients with subcortical vascular cognitive impairment: a quantitative analysis of digitized spiral drawing metrics. Sci Rep 2025; 15:3955. [PMID: 39890926 PMCID: PMC11785735 DOI: 10.1038/s41598-025-88604-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 01/29/2025] [Indexed: 02/03/2025] Open
Abstract
Subcortical vascular cognitive impairment (SVCI) is caused by white matter degeneration. Multiple lacunar infarction due to deep small vascular disease around the subcortical structure and incomplete infarction of white matter owing to decreased perfusion are some of the causes of vascular cognitive impairment. Damage to subcortical structures and prefrontal-cortical circuits can affect motor skills along with cognitive abilities. In this study, we identified the indicators, such as pen pressure, speed, and deviation (degree of deviation from the target line), which can be observed in drawing performance in patients with SVCI. A total of 24 patients with SVCI and 26 healthy adults (HC) were subjected to digitized drawing along straight lines and spiral drawing (drawing along spiral lines, free spiral drawing). In the drawing along straight lines, the SVCI group showed a greater deviation than the HC group. In the drawing along spiral lines, the SVCI group showed greater pen pressure and deviation than the HC group. In the free spiral drawing tasks, the SVCI group showed greater pen pressure and deviation than the HC group. In the free spiral drawing task, the deviation of the SVCI group increased as the wheels of the spiral increased in the clockwise and counterclockwise directions. The SVCI group showed greater pressure to hold and press pencils during drawing compared to HC due to damage to cognitive and motor skills; Further, it deviated from the provided target line. These results may be due to complex cognitive-motor deficits, motor patterns, or impaired motor termination and conversion following damage to the frontal-subcortical circuit. This study provides essential clinical basic data that can be utilized to precisely determine the diminished kinematic behavior within the SVCI group.
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Affiliation(s)
- Hyo Jeong Kim
- Department of Speech-Language Pathology, Graduate School of Health Sciences, Hallym University, Chuncheon, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Yoon
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, Hallym University, Chuncheon, Republic of Korea.
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Wang Y, Zhi H, Zhang X. Effect of Huangdisan grain on improving cognitive impairment in VD rats and its mechanism in immune inflammatory response. J Neuroimmunol 2023; 377:578058. [PMID: 36871311 DOI: 10.1016/j.jneuroim.2023.578058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Vascular dementia (VD) is the second most common type of dementia after Alzheimer's disease (AD). Although the incidence rate is very high, there is no definitive treatment for VD. And it has serious impact on the quality of life of VD patients. In recent years, more and more studies about the clinical efficacy and pharmacological effects of traditional Chinese medicine (TCM) in the treatment of VD have been conducted. And Huangdisan grain has been used to treat VD patients with a good curative effect in clinic. OBJECTIVE This study was designed to investigate the effect of Huangdisan grain on the inflammatory response and cognitive function of VD rats modeled by bilateral common carotid artery occlusion (BCCAO), that aimed to improve the treatment methods for VD. METHODS 8-week-old healthy SPF male Wistar rats (280 ± 20 g) were randomly divided into the normal group (Gn, n = 10), sham operated group (Gs, n = 10), and operated group (Go, n = 35). The VD rat models in Go group were established by BCCAO. 8 weeks after surgery, the operated rats were screened by the hidden platform trail of Morris Water Maze (MWM), and the rats with cognitive dysfunction were further randomly divided into the impaired group (Gi, n = 10) and TCM group (Gm, n = 10). The VD rats in Gm group were given the intragastric administration of Huangdisan grain decoction once a day for 8 weeks, and the other groups were given intragastric administration of normal saline. Then the cognitive ability of rats in each group was detected by the MWM Test. The lymphocyte subsets in peripheral blood and hippocampus of rats were measured by flow cytometry. The levels of cytokines (IL-1β, IL-2, IL-4, IL-10, TNF-α, INF-γ, MIP-2, COX-2, iNOS) in peripheral blood and hippocampus were measured by ELISA (enzyme linked immunosorbent assay). The number of Iba-1+ CD68+ co-positive cells in the CA1 region of hippocampus was measured by immunofluorescence. RESULTS Compared with the Gn group, the escape latencies of the Gi group were prolonged (P < 0.01), the time spent in the former platform quadrant was shortened (P < 0.01), and the number of times of crossing over the former platform location was reduced (P < 0.05). But compared with the Gi group, the escape latencies of Gm group were shortened (P < 0.01), the time spent in the former platform quadrant was prolonged (P < 0.05), and the number of times of crossing over the former platform location was increased (P < 0.05). The number of Iba-1+ CD68+ co-positive cells in the CA1 region of hippocampus of VD rats in Gi group was increased (P < 0.01) compared with the Gn group. And the proportions of T Cells, CD4+ T Cells, CD8+ T Cells in the hippocampus were increased (P < 0.01). The level of pro-inflammatory cytokines in the hippocampus was increased significantly, such as IL-1β (P < 0.01), IL-2 (P < 0.01), TNF-α (P < 0.05), IFN-γ (P < 0.01), COX-2 (P < 0.01), MIP-2 (P < 0.01) and iNOS (P < 0.05). And the level of IL-10 (P < 0.01), a kind of anti-inflammatory cytokine, was decreased. The proportions of T Cells (P < 0.05), CD4+ T Cells (P < 0.01) and NK Cells (P < 0.05) in the peripheral blood of the VD rats in Gi group were decreased, and the level of IL-1β, IL-2, TNF-α, IFN-γ, COX-2, MIP-2 and iNOS was increased significantly (P < 0.01) compared with the Gn group. Meanwhile, the level of IL-4 and IL-10 was decreased (P < 0.01). Huangdisan grain could reduce the number of Iba-1+ CD68+ co-positive cells in the CA1 region of hippocampus (P < 0.01), decrease the proportions of T Cells, CD4+ T Cells, CD8+ T Cells and the level of IL-1β, MIP-2 in hippocampus (P < 0.01) of VD rats. Moreover, it could rise the proportion of NK Cells (P < 0.01) and the level of IL-4 (P < 0.05), IL-10 (P < 0.05), and decrease the level of IL-1β (P < 0.01), IL-2 (P < 0.05), TNF-α (P < 0.01), IFN-γ (P < 0.01), COX-2 (P < 0.01) and MIP-2 (P < 0.01) in peripheral blood of VD rats. CONCLUSION This study indicated that Huangdisan grain could decrease the activation of microglia/macrophages, regulate the proportions of lymphocyte subsets and the level of cytokines, which could adjust the immunologic abnormalities of VD rats, and ultimately improve cognitive function.
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Affiliation(s)
- Yao Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300380, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300380, China
| | - Hui Zhi
- The Ninth People's Hospital of Chongqing, Chongqing 400799, China
| | - Xuezhu Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300380, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300380, China.
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Sapsford TP, Johnson SR, Headrick JP, Branjerdporn G, Adhikary S, Sarfaraz M, Stapelberg NJC. Forgetful, sad and old: Do vascular cognitive impairment and depression share a common pre-disease network and how is it impacted by ageing? J Psychiatr Res 2022; 156:611-627. [PMID: 36372004 DOI: 10.1016/j.jpsychires.2022.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022]
Abstract
Vascular cognitive impairment (VCI) and depression frequently coexist in geriatric populations and reciprocally increase disease risks. We assert that a shared pre-disease state of the psycho-immune-neuroendocrine (PINE) network model mechanistically explains bidirectional associations between VCI and depression. Five pathophysiological sub-networks are identified that are shared by VCI and depression: neuroinflammation, kynurenine pathway imbalance, hypothalamic-pituitary-adrenal (HPA) axis overactivity, impaired neurotrophic support and cerebrovascular dysfunction. These do not act independently, and their complex interactions necessitate a systems biology approach to better define disease pathogenesis. The PINE network is already established in the context of non-communicable diseases (NCDs) such as depression, hypertension, atherosclerosis, coronary heart disease and type 2 diabetes mellitus. We build on previous literature to specifically explore mechanistic links between MDD and VCI in the context of PINE pathways and discuss key mechanistic commonalities linking these comorbid conditions and identify a common pre-disease state which precedes transition to VCI and MDD. We expand the model to incorporate bidirectional interactions with biological ageing. Diathesis factors for both VCI and depression feed into this network and the culmination of shared mechanisms (on an ageing substrate) lead to a critical network transition to one or both disease states. A common pre-disease state underlying VCI and depression can provide clinicians a unique opportunity for early risk assessment and intervention in disease development. Establishing the mechanistic elements and systems biology of this network can reveal early warning or predictive biomarkers together with novel therapeutic targets. Integrative studies are recommended to elucidate the dynamic networked biology of VCI and depression over time.
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Affiliation(s)
- Timothy P Sapsford
- Griffith University School of Medicine, Gold Coast, Queensland, Australia; Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Susannah R Johnson
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - John P Headrick
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | - Grace Branjerdporn
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
| | - Sam Adhikary
- Mater Young Adult Health Centre, Mater Hospital, Brisbane, Queensland, Australia
| | - Muhammad Sarfaraz
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Nicolas J C Stapelberg
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Ko TY, Kao HL, Yeh CF, Lin JH, Huang CC, Chen YH, Chao CC, Li HY, Chan CY, Lin LC, Chen YS, Wang MJ, Lin MS. Serial neurocognitive changes following transcatheter aortic valve replacement: comparison between low and intermediate-high risk groups. Aging (Albany NY) 2022; 14:6111-6127. [PMID: 35939340 PMCID: PMC9417238 DOI: 10.18632/aging.204202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
Background: Data comparing the neurocognitive trajectory between low and intermediate-high risk patients following transcatheter aortic valve replacement (TAVR) is never reported. Aims: To report serial neurocognitive changes up to 1 year post-TAVR in low and intermediate-high risk groups as well as overall cohort. Methods: Prospective neurological assessments (NIHSS and Barthel Index), global cognitive tests (MMSE and Alzheimer Disease Assessment Scale–Cognitive Subtest, ADAS-cog) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR. Results: In overall cohort, persistent improvement to 1 year in MMSE, ADAS-cog, Color Trail Test A and B was found. According to the STS score, the study cohort was divided into low (<4%, N = 81) and intermediate-high (≧4%, N = 75) risk groups. The baseline neurologic and cognitive performance was significantly worse in intermediate-high risk group. Slight improvement on general neurological functions (Barthel index and proportion of NIHSS>0 patients) at 1 year could be observed only in intermediate-high risk group. In global cognitive assessments, improvement in MMSE and ADAS-cog at 1 year was found in both groups, but the proportion of cognitive improvement was more obvious in intermediate-high risk group. In Color Trail Tests and verbal fluency, significant and persistent improvement up to 1 year could be observed only in low risk group. Conclusions: TAVR was associated with persistent improvement in global cognitive function, as well as in attention and psychomotor processing speed, up to 1 year in overall cohort. However, improvement in tests for executive functions can only be seen in low risk group.
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Affiliation(s)
- Tsung-Yu Ko
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fan Yeh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiu-Hsiang Lin
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yang Chan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Jiuh Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Cognitive Functions after Carotid Artery Stenting-1-Year Follow-Up Study. J Clin Med 2022; 11:jcm11113019. [PMID: 35683407 PMCID: PMC9180931 DOI: 10.3390/jcm11113019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/29/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The revascularization of carotid arteries minimizes the risk of future cerebral stroke and usually improves cognitive functions. The aim of this study was to assess changes in cognitive function and verify the hypothesis assuming an improvement of selected cognitive functions—psychomotor speed, visuospatial episodic memory, executive function and verbal fluency—in patients after carotid artery stenting during a 12-month follow-up. Methods: 47 persons subject to CAS, including 13 symptomatic persons, were examined before and 12 months after a procedure with a psychological test battery (digit symbol test—DS, Rey–Osterrieth complex figure test—ROCF, Wisconsin Card Sorting Test—WCST, letter verbal fluency—LVF). Sociodemographic data and clinical parameters were acquired from an author questionnaire. Results: The one-year follow-up, after the performed CAS procedure, demonstrated a significant improvement of psychomotor speed, visuospatial episodic memory, and executive function. No changes in the area of verbal fluency or decline in any of cognitive functions under analysis were observed. Conclusions: Carotid artery stenting improves cognitive functioning, both in the area of basic and more complex cognitive functions in persons with carotid atherosclerosis.
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Kang ES, Yook JS, Ha MS. Breathing Exercises for Improving Cognitive Function in Patients with Stroke. J Clin Med 2022; 11:jcm11102888. [PMID: 35629013 PMCID: PMC9144753 DOI: 10.3390/jcm11102888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with stroke may experience a certain degree of cognitive decline during the period of recovery, and a considerable number of such patients have been reported to show permanent cognitive damage. Therefore, the period of recovery and rehabilitation following stroke is critical for rapid cognitive functional improvements. As dysfunctional breathing has been reported as one of the factors affecting the quality of life post stroke, a number of studies have focused on the need for improving the breathing function in these patients. Numerous breathing exercises have been reported to enhance the respiratory, pulmonary, cognitive, and psychological functions. However, scientific evidence on the underlying mechanisms by which these exercises improve cognitive function is scattered at best. Therefore, it has been difficult to establish a protocol of breathing exercises for patients with stroke. In this review, we summarize the psychological, vascular, sleep-related, and biochemical factors influencing cognition in patients and highlight the need for breathing exercises based on existing studies. Breathing exercises are expected to contribute to improvements in cognitive function in stroke based on a diverse array of supporting evidence. With relevant follow-up studies, a protocol of breathing exercises can be developed for improving the cognitive function in patients with stroke.
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Affiliation(s)
- Eui-Soo Kang
- Department of Sports Science Convergence-Graduate School, Dongguk University-Seoul, 30, Pildong-ro 1-gil, Jung-gu, Seoul 04620, Korea;
| | - Jang Soo Yook
- Center for Functional Connectomics, Brain Research Institute, Korea Institute of Science and Technology (KIST), Hwarang-ro 14-gil 5, Seongbuk-gu, Seoul 02792, Korea;
| | - Min-Seong Ha
- Department of Sports Culture, College of the Arts, Dongguk University-Seoul, 30, Pildong-ro 1-gil, Jung-gu, Seoul 04620, Korea
- Correspondence: ; Tel.: +82-2-2290-1926
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Huang P, He XY, Xu M. Effects of Carotid Artery Stent and Carotid Endarterectomy on Cognitive Function in Patients with Carotid Stenosis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6634537. [PMID: 33381568 PMCID: PMC7762647 DOI: 10.1155/2020/6634537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Carotid artery stenosis is closely related to cognitive dysfunction, in which decreased cerebral perfusion is one of the important factors. Both carotid artery stent implantation and carotid endarterectomy can relieve stenosis and increase cerebral perfusion. In this study, we aimed to compare the effects of carotid artery stent implantation and endarterectomy on cognitive function. METHODS A total of 98 patients with carotid artery stenosis hospitalized in our hospital from July 2015 to January 2017 were included. Among them, 50 cases underwent carotid artery stent implantation treatment as stent implantation group (CAS group), and 48 cases underwent carotid artery endarterectomy treatment as carotid endarterectomy group (CEA group). Using the Mini-Mental State Examination Scale (MMSE Scale) and the Montreal Cognitive Assessment Scale (MoCA Scale), the cognitive function scores of the two groups of patients before and after 3 and 6 months of operation were measured, and the patients were also measured before and after surgery, after the serum NSE, hs-CRP content. RESULTS The serum NSE, hs-CRP content, MMSE score, and MoCA score of the two groups before treatment were not statistically significant (P > 0.05). The MMSE score and MoCA score of the two groups of patients before treatment were lower than the normal value, suggesting carotid artery stenosis combined with different degrees of cognitive dysfunction. Carotid artery stenosis is different, and patients' cognitive function is also different. The MMSE score and MoCA score of the two groups at 3 and 6 months after operation were higher than before treatment, and there was a statistically significant difference between 6 and 3 months after operation (P < 0.05), but at each time There was no statistically significant difference between the two groups (P > 0.05). The NSE content of the two groups of patients after operation decreased compared with that before treatment, and the decrease in 6 months after operation was more obvious than that in March (P < 0.05). However, the difference between the two groups at each time point was not statistically significant (P > 0.05). The content of hs-CRP in the two groups of patients was higher than that before the operation, and the CAS group was significantly higher than the CEA group; the difference was statistically significant (P < 0.05). CONCLUSION Carotid artery stent and carotid endarterectomy are effective in improving the cognitive function of patients with carotid stenosis, but there is no significant difference between the two.
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Affiliation(s)
- Pan Huang
- Department of Neurology, People's Hospital of Deyang City, No. 173 TaiShan North Road, DeYang, Sichuan 618000, China
| | - Xiao-ying He
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, No. 25, Taiping Street, Jiangyang District, Luzhou City, Sichuan 646000, China
| | - Min Xu
- Department of Neurology, The Second People's Hospital of Deyang City, No. 340 Minjiang West Road, DeYang, Sichuan 618000, China
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Tian A, Li W, Zai Q, Li H, Zhang RW. 3‑N‑Butyphthalide improves learning and memory in rats with vascular cognitive impairment by activating the SIRT1/BDNF pathway. Mol Med Rep 2020; 22:525-533. [PMID: 32377741 PMCID: PMC7248482 DOI: 10.3892/mmr.2020.11106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/04/2020] [Indexed: 12/12/2022] Open
Abstract
Vascular cognitive impairment (VCI) is a type of cerebral vascular disorder that leads to learning and memory decline. VCI models can be induced by chronic cerebral hypoperfusion via permanent bilateral common carotid artery occlusion. 3-N-Butylphthalide (NBP) is a neuroprotective drug used for the treatment of ischemic cerebrovascular diseases. Silent information regulator 1 (SIRT1) plays an important role in memory formation and cognitive performance, and its abnormal reduction is associated with cognitive dysfunction in neurodegenerative diseases. Brain-derived neurotrophic factor (BDNF) is a neurotrophic factor that plays critical roles in promoting neuronal growth and injury repair. The present study was performed to investigate the effects and the underlying mechanism of NBP on learning deficits in a rat model of VCI. Rats were divided into a control group, model group, low-NBP-dose group (30 mg/kg/day), high-NBP-dose group (60 mg/kg/day), NBP + SIRT1 inhibitor group and NBP + BDNF inhibitor group. Rats were then subjected to Morris water maze and T-maze tests, which identified that NBP treatment significantly attenuated memory impairments in VCI rats. Molecular examination indicated that SIRT1 and BDNF expression levels in the hippocampus were increased by NBP treatment. However, NBP failed to ameliorate cognitive function after inhibition of the SIRT1/BDNF signaling pathway. In addition, NBP in combination with a SIRT1 inhibitor suppressed BDNF protein expression, but inhibition of BDNF did not inhibit SIRT1 protein expression in rats with VCI. The present results suggested that the neuroprotective effects of NBP on learning deficits in a rat model of VCI may be via regulation of the SIRT1/BDNF signaling pathway, in which SIRT1 may be the upstream signaling molecule. Therefore, the SIRT1/BDNF pathway could be a potential therapeutic target for VCI.
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Affiliation(s)
- Ayong Tian
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Wan Li
- Department of Neurology, The Ninth People's Hospital of Shenyang, Shenyang, Liaoning 110024, P.R. China
| | - Qing Zai
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Hui Li
- Department of Gerontology and Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Rong-Wei Zhang
- Department of Gerontology and Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Vladimirskiy EV, Karakulova YV, Tsepilov SV. [Dynamics of the cognitive sphere indicators and neurotrophic factors in the course of balneotherapy of dyscirculatory encephalopathy]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2019; 96:4-10. [PMID: 31095123 DOI: 10.17116/kurort2019960214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The natural factors of therapeutic significance play an important role in the rehabilitation of the patients suffering from chronic disorders of cerebral circulation since they are known to promote the development of the compensatory and adaptive processes. However, there is virtually no information in the relevant literature publications about the influence of balneotherapy on the dynamics of the cognitive sphere indicators and neurotrophic factors. AIMS The objective of the present study was to evaluate the effectiveness of balneotherapy as a component of the combined treatment of the patients presenting with discirculatory encephalopathy based on the investigations into dynamics of the neuropsychological status and the quantitative content of the neurotrophic factors in the peripheral blood, with special reference to the brain-derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF), in the patients receiving the balneotherapeutic treatment based at they at the 'Kluchi' health resort. MATERIAL AND METHODS A total of 72 patients presenting with the 1st and 2nd stages of chronic cerebral ischemia were examined (including 9 men and 63 women at the mean age of 62.2±2.1 years). They were given the health resort -based treatment during 14 days while staying at the 'Kluchi' resort located in the Perm region. The examination of all the patients included the psychometric testing and the determination of blood serum neurotrophic factors (BDNF and CNTF). The patients were allocated to three groups depending on the character of the prescribed treatment. The first group consisted of 29 subjects, who were given the conventional therapy (the alternation of hydrogen sulphide muds and baths number 7, daily massage of the neck-collar region in the combination with exercise therapy). The second group was comprised of 32 persons who received the standard course of chloride-sodium bromine baths number 7. The third group was composed of 11 persons suffering from chronic cerebral ischemia who received no balneo- or peloid therapy whatever. RESULTS The study has revealed the different stages of cognitive and emotional disorders combined with the initially reduced level of BDNF in the blood serum of the examined patients. The level of BDNF in the peripheral blood of the patients comprising the first group increased from 3.68±2.15 to 5.02±2.88 ng/ml after the course of balneotherapy. These values were significantly higher than before the treatment (p=0.000). In the patients of the second group, the level of situational and personal anxiety estimated with the use of the Spielberger-Khanin test decreased in association with the improvement in the cognitive sphere after they received the standard course of balneotherapy including the usual chloride-sodium bromine baths. Simultaneously, the level of BDNF in the peripheral blood of these patents increased from 4.00±2.3 to 5.39±2.44 ng/ml (p=0.02). The patients of the third group, who were given no treatment whatever displayed no statistically significant changes of the studied parameters. CONCLUSION The health resort-based treatment including the course of chloride-sodium bromine baths has a direct beneficial influence on the neuroreparative and neuroprotective functions in the patients presenting with chronic cerebral ischemia owing to the increase in the level of neurotrophic factors in the blood.
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Affiliation(s)
| | | | - S V Tsepilov
- ZAO 'Klyuchi Health Resort', Permsky krai, Russia
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Abstract
Clinical investigations designed to contrast the efficacy of carotid endarterectomy (CEA) versus best medical therapy and CEA versus carotid artery stenting (CAS) in patients with carotid artery stenosis have been based on the traditional endpoints of stroke, myocardial infarction, and death. Cognitive function is being increasingly recognized as an important outcome measure that affects patient well-being and functional status. However, it has not been evaluated systematically in the context of carotid revascularization. A decline in cognitive function could occur from microembolic ischemia during surgical dissection (CEA) or intravascular instrumentation (CAS). It could also occur from hypoperfusion during clamping (CEA) or balloon dilation (CAS). Conversely, restoring perfusion could improve cognitive dysfunction that might have occurred from a state of chronic hypoperfusion. It is still unclear whether these complex interactions ultimately result in a net improvement or a deterioration of cognitive function. Furthermore, it is not known whether the 2 methods of carotid revascularization have a differential effect on cognitive outcomes. It is becoming increasingly clear, though, that there is a positive relationship between improvement in cognition and improvement in functional outcome of patients. Vascular surgeons will be well served to remain informed and even actively engaged in the development of this field if they wish to continue providing the high-quality, well-informed care they have traditionally offered to patients with carotid stenosis.
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Affiliation(s)
- Brajesh K Lal
- Departments of Surgery and Physiology, UMDNJ-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA.
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Frances A, Sandra O, Lucy U. Vascular cognitive impairment, a cardiovascular complication. World J Psychiatry 2016; 6:199-207. [PMID: 27354961 PMCID: PMC4919258 DOI: 10.5498/wjp.v6.i2.199] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 02/05/2023] Open
Abstract
Over the past two decades, the term vascular cognitive impairment (VCI) has been used to refer to a spectrum of cognitive decline characterized by executive dysfunction, associated with vascular pathology. With 30% of stroke survivors showing cognitive impairments, it is regarded as the most common cause of cognitive impairment. This is a narrative review of available literature citing sources from PubMed, MEDLINE and Google Scholar. VCI has a high prevalence both before and after a stroke and is associated with great economic and caregiver burden. Despite this, there is no standardized diagnostic criteria for VCI. Hypertension has been identified as a risk factor for VCI and causes changes in cerebral vessel structure and function predisposing to lacuna infarcts and small vessel haemorrhages in the frontostriatal loop leading to executive dysfunction and other cognitive impairments. Current trials have shown promising results in the use of antihypertensive medications in the management of VCI and prevention of disease progression to vascular dementia. Prevention of VCI is necessary in light of the looming dementia pandemic. All patients with cardiovascular risk factors would therefore benefit from cognitive screening with screening instruments sensitive to executive dysfunction as well as prompt and adequate control of hypertension.
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Wu X, Lai Y, Zhang Y, Yao L, Wen X. Breakdown of Sensorimotor Network Communication in Leukoaraiosis. NEURODEGENER DIS 2015; 15:322-30. [PMID: 26287381 DOI: 10.1159/000435918] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 06/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leukoaraiosis (LA) patients may suffer from sensorimotor dysfunctions. The relationship between behavioral disturbances and changes in the sensorimotor network (SMN) has not been thoroughly elucidated. OBJECTIVE This study investigated the hypothesized breakdown of communication of SMN and its behavioral consequences in LA. METHODS Fluid-attenuated inversion recovery (FLAIR) images, resting-state functional magnetic resonance images (fMRI) and behavioral data were collected from 30 LA patients and 26 healthy individuals (normal controls, NC). The subjects were grouped according to LA severity, as indicated by their FLAIR images. Group independent component analysis was applied to the fMRI data to map the functional connectivity of SMN for NC and LA patients. A whole-brain, voxel-wise analysis was employed to investigate the functional connectivity alteration of SMN in LA. The relationships between LA severity, functional connectivity alteration of the SMN and behavioral clinical symptoms were examined by correlation analysis. RESULTS The right cingulate motor area (rCMA), left posterior insula and left ventral premotor area showed attenuated functional connectivity in the LA patients. The extent of the attenuation was related to the severity of the disease. Furthermore, the attenuation in the rCMA was associated with worse sensorimotor integration performance. CONCLUSIONS These results suggest that LA impairs sensorimotor integration by interfering with the communication or coordination of these aforementioned regions related to the SMN.
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Affiliation(s)
- Xia Wu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
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Small vessel disease and memory loss: what the clinician needs to know to preserve patients' brain health. Curr Cardiol Rep 2014; 15:427. [PMID: 24105643 DOI: 10.1007/s11886-013-0427-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Small vessel disease (SVD) in the brain manifests in the periventricular and deep white matter and radiographically is described as "leukoaraiosis". It is increasingly recognized as a cause of morbidity from middle age onward and this clinical relevance has paralleled advances in the field of neuroradiology. Overall, SVD is a heterogenous group of vascular disorders that may be asymptomatic, or a harbinger of many conditions that jeopardize brain health. Management and prevention focuses on blood pressure control, lifestyle modification, and symptomatic treatment.
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Yanhong O, Chandra M, Venkatesh D. Mild cognitive impairment in adult: A neuropsychological review. Ann Indian Acad Neurol 2014; 16:310-8. [PMID: 24101808 PMCID: PMC3788272 DOI: 10.4103/0972-2327.116907] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/29/2013] [Accepted: 07/07/2013] [Indexed: 12/31/2022] Open
Abstract
Mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. This is clinically relevant overt dementia can be prevented if treatment strategies are devised for MCI. Neuropsychological deficits in this condition are very common and are important clinically for treatment and outcomes. We aimed to review various neuropsychological deficits in MCI. Further, we have presented the current evidence for nosological status, neuroanatomical basis, and clinical outcome of this heterogeneous construct. All published papers on the topic of neuropsychological deficits in MCI on Medline and other databases were reviewed. A wide range of memory and executive function deficits are common in MCI patients. However, several studies are limited by either improper designs or inadequate sample sizes. Several neuropsychological impairments like memory function and executive functions can be diagnosed in MCI. The evidence base for the exact neuroanatomical basis of MCI is not robust yet. However, given the wide range of outcomes, controversies and debates exist regarding the nosological significance of the deficits. Hence, more studies are needed to specifically locate the impairments and further delineate the construct of MCI.
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Affiliation(s)
- Ouyang Yanhong
- Hainan People's Hospital, First Aid Center EICU, Hainan, China
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Yoo DH, Hong DG, Lee JS. The Standardization of the Clock Drawing Test (CDT) for People with Stroke Using Rasch Analysis. J Phys Ther Sci 2014; 25:1587-90. [PMID: 24409026 PMCID: PMC3885845 DOI: 10.1589/jpts.25.1587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to standardize the clock drawing test (CDT) for
people with stroke using Rasch analysis. [Subjects and Methods] Seventeen items of the CDT
identified through a literature review were performed by 159 stroke patients. The data was
analyzed with Winstep version 3.57 using the Rasch model to examine the unidimensionality
of the items’ fit, the distribution of the items’ difficulty, and the reliability and
appropriateness of the rating scale. [Result] Ten out of the 159 participations (6.2%)
were considered misfit subjects, and one item of the CDT was determined to be a misfit
item based on Rasch analysis. The rating scales were judged as suitable because the
observed average showed an array of vertical orders and MNSQ values < 2. The separate
index and reliability of the subject (1.98, 0.80) and item (6.45, 0.97) showed relatively
high values. [Conclusion] This study is the first to examine the CDT scale in stroke
patients by Rasch analysis. The CDT is expected to be useful for screening stroke patients
with cognitive problems.
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Affiliation(s)
- Doo Han Yoo
- Department of Occupational Therapy, Chonbuk National University Hospital, Republic of Korea
| | - Deok Gi Hong
- Department of Occupational Therapy, Wonkwang University Oriental Medical Hospital, Republic of Korea
| | - Jae Shin Lee
- Department of Occupational Therapy, Graduate School of Konyang University: 158 Kwanjeo, Seo, Daejeon 302-718, Republic of Korea
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Tu Q, Ding B, Yang X, Bai S, Tu J, Liu X, Wang R, Tao J, Jin H, Wang Y, Tang X. The current situation on vascular cognitive impairment after ischemic stroke in Changsha. Arch Gerontol Geriatr 2013; 58:236-47. [PMID: 24148887 DOI: 10.1016/j.archger.2013.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 09/26/2013] [Accepted: 09/28/2013] [Indexed: 11/19/2022]
Abstract
The objectives of the study were to explore the prevalence and effects of vascular cognitive impairment (VCI) among ischemic stroke patients and to provide a basis for prevention and treatment strategies. A stratified cluster random sampling method was performed, and 689 ischemic stroke patients (over 40 years of age) were enrolled. All of the patients had received a neuropsychological assessment battery to assess cognitive function and self-designed questionnaires to collect relevant information. According to the cognitive status, the patients were divided into two groups, a case group and a control group. The caregivers of the patients were given a questionnaire concerning the awareness of and attitudes toward VCI. In this study, we determined that the prevalence of VCI was 41.8%. Aging, paraventricular white matter lesion (WML), macroangiopathy, high levels of alcohol, a lack of hobbies, and excessive sleep were risk factors for vascular cognitive impairment no dementia (VCIND). A high level of education, manual-work, low level of alcohol use, regular health checks, a vegetable-based diet, and more fruit and milk were protective factors for VCIND. Living alone, hyperlipidemia, transient ischemic attack, a family history of stroke, and brain atrophy were risk factors of vascular dementia (VD). A high educational level, a vegetable-based diet, and tea were protective factors for VD. The general public awareness of VCI was found to be insufficient, and there was a prejudice toward and lack of funding for the care of VCI patients. The prevalence of VCI is high in ischemic stroke patients, and there are different impact factors at different stages. Despite the high prevalence of VCI, the general public awareness is limited. Appropriate prevention measures should be developed to reduce the prevalence of VCI.
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Affiliation(s)
- Qiuyun Tu
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Binrong Ding
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Xia Yang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Song Bai
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Junshi Tu
- Department of Rehabilitation Therapy, Zhongshan School of Medicine in Sun Yat-Sen University, 510080, China
| | - Xiao Liu
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Ranran Wang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Jinghua Tao
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Hui Jin
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Yiqun Wang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha 410011, China.
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Huang CC, Chen YH, Lin MS, Lin CH, Li HY, Chiu MJ, Chao CC, Wu YW, Chen YF, Lee JK, Wang MJ, Chen MF, Kao HL. Association of the Recovery of Objective Abnormal Cerebral Perfusion With Neurocognitive Improvement After Carotid Revascularization. J Am Coll Cardiol 2013; 61:2503-9. [DOI: 10.1016/j.jacc.2013.02.059] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 01/01/2013] [Accepted: 02/14/2013] [Indexed: 11/30/2022]
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Smallwood A, Oulhaj A, Joachim C, Christie S, Sloan C, Smith AD, Esiri M. Cerebral subcortical small vessel disease and its relation to cognition in elderly subjects: a pathological study in the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort. Neuropathol Appl Neurobiol 2012; 38:337-43. [DOI: 10.1111/j.1365-2990.2011.01221.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ferrer I. Cognitive impairment of vascular origin: neuropathology of cognitive impairment of vascular origin. J Neurol Sci 2010; 299:139-49. [PMID: 20846674 DOI: 10.1016/j.jns.2010.08.039] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 08/15/2010] [Accepted: 08/24/2010] [Indexed: 12/31/2022]
Abstract
The term cognitive impairment of vascular origin is used to designate global cognitive deficits as well as focal neurological deficits such as aphasia, apraxia and agnosia of vascular/circulatory origin. It has been useful for identifying early clinical and neuroradiological alterations that might permit therapeutic strategies geared to curbing the progression of cerebrovascular disease. Multi-infarct encephalopathy, infarcts in strategic areas, lacunae and lacunar status, Binswanger's encephalopathy, hippocampal sclerosis, cortical granular atrophy and watershed infarcts are common lesions. Hypertension and vascular diseases such as arteriosclerosis, small blood vessel disease, inflammatory diseases of the blood vessels, Sneddon syndrome, cerebral amyloid angiopathies, cerebral autosomic dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), and Maeda's syndrome are causative of cognitive impairment of vascular origin. Other less common causes are hereditary endotheliopathy with retinopathy, neuropathy and strokes (HERNS), cerebro-retinian vasculopathy (CRV), hereditary vascular retinopathy (HVR) (all three linked to 3p21.1-p21.3), hereditary infantile hemiparesis with arteriolar retinopathy and leukoencephalopathy (HIHRATL) (not linked to 3p21), fibromuscular dysplasia, and moya-moya disease. Lack of uniformity of clinical manifestations, the variety of vascular diseases and circulatory factors, the diverse, but often convergent, neuropathological substrates, and the common association with unrelated neurodegenerative diseases in the elderly, make it hard to assume a single clinical approach in the diagnosis and treatment of cognitive impairment of vascular origin. Rather, environmental and genetic risk factors, underlying vascular diseases, associated systemic, metabolic and neurodegenerative diseases and identification of extent and distribution of lesions with morphological and functional neuroimaging methods should be applied in every individual patient.
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Affiliation(s)
- Isidre Ferrer
- Institut de Neuropatologia, Servei Anatomia Patològica, IDIBELL-Hospital Universitari de Bellvitge, 08907 Hospitalet de LLobregat, Spain.
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Health effects with consumption of the flax lignan secoisolariciresinol diglucoside. Br J Nutr 2009; 103:929-38. [PMID: 20003621 DOI: 10.1017/s0007114509992753] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Flaxseed is the richest source of the lignan secoisolariciresinol diglucoside (SDG). After ingestion, SDG is converted to secoisolariciresinol, which is further metabolised to the mammalian lignans enterodiol and enterolactone. A growing body of evidence suggests that SDG metabolites may provide health benefits due to their weak oestrogenic or anti-oestrogenic effects, antioxidant activity, ability to induce phase 2 proteins and/or inhibit the activity of certain enzymes, or by mechanisms yet unidentified. Human and animal studies identify the benefits of SDG consumption. SDG metabolites may protect against CVD and the metabolic syndrome by reducing lipid and glucose concentrations, lowering blood pressure, and decreasing oxidative stress and inflammation. Flax lignans may also reduce cancer risk by preventing pre-cancerous cellular changes and by reducing angiogenesis and metastasis. Thus, dietary SDG has the potential to decrease the incidence of several chronic diseases that result in significant morbidity and mortality in industrialised countries. The available literature, though, makes it difficult to clearly identify SDG health effects because of the wide variability in study methods. However, the current evidence suggests that a dose of at least 500 mg SDG/d for approximately 8 weeks is needed to observe positive effects on cardiovascular risk factors in human patients. Flaxseed and its lignan extracts appear to be safe for most adult populations, though animal studies suggest that pregnant women should limit their exposure. The present review discusses the potential health benefits of SDG in humans, with supporting evidence from animal studies, and offers suggestions for future research.
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Zhou A, Jia J. A screen for cognitive assessments for patients with vascular cognitive impairment no dementia. Int J Geriatr Psychiatry 2009; 24:1352-7. [PMID: 19347838 DOI: 10.1002/gps.2265] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To screen for cognitive assessment for patients with vascular cognitive impairment (VCI) no dementia (V-CIND) from a set of cognitive measures. METHODS Extensive neuropsychological tests covering five cognitive domains were performed on 80 V-CIND patients and 80 normal controls. The impaired domains in V-CIND were determined and the most discriminating tests were selected to form a comprehensive assessment. The discriminating validity of the individual tests and the comprehensive assessment were explored. RESULTS Compared with the control group, five cognitive domains were all impaired in V-CIND group. World Health Organization-University of California-Los Angeles Auditory Verbal Learning Test (WHO-UCLA AVLT) immediate recall, Semantic Category Verbal Fluency Test (animal), Chinese version of the Wechsler Adult Intelligence Test (WAIS-RC) Digit Symbol Subtest, and Block Design Subtest were finally selected to form a comprehensive assessment tool, which achieved a sensitivity of 92.5% and a specificity of 98.8% in differentiating V-CIND patients from normal controls. Even in the subjects with Mini-Mental State Examination (MMSE) scores of 28 or above, high discriminative validity was also obtained. CONCLUSIONS Our study revealed a multiple domain cognitive deficit in V-CIND patients. The comprehensive assessment tapping memory, executive functions, mental processing speed, and visuoconstructive skill may be potentially useful for an overall cognitive evaluation for V-CIND.
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Affiliation(s)
- Aihong Zhou
- Department of Neurology, Xuanwu Hospital of the Capital Medical University, Beijing, China
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Heterogeneity in mild cognitive impairment: differences in neuropsychological profile and associated white matter lesion pathology. J Int Neuropsychol Soc 2009; 15:906-14. [PMID: 19891820 PMCID: PMC3034688 DOI: 10.1017/s1355617709990257] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examined whether distinct neuropsychological profiles could be delineated in a sample with Mild Cognitive Impairment (MCI) and whether white matter lesion (WML) burden contributed to MCI group differences. A heterogeneous, clinical sample of 70 older adults diagnosed with MCI was assessed using cognitive scores, and WML was quantified using a semi-automated, volumetric approach on T2-weighted fluid-attenuated inversion recovery (FLAIR) images. Using cluster and discriminant analyses, three distinct groups (Memory/Language, Executive/Processing Speed, and Pure Memory) were empirically derived based on cognitive scores. Results also showed a dose dependent relationship of WML burden to MCI subgroup, with the Executive/Processing Speed subgroup demonstrating significantly higher levels of WML pathology when compared to the other subgroups. In addition, there was a dissociation of lesion type by the two most impaired subgroups (Memory/Language and Executive/Processing Speed) such that the Memory/Language subgroup showed higher periventricular lesion (PVL) and lower deep white matter lesion (DWML) volumes, whereas the Executive/Processing Speed demonstrated higher DWML and lower PVL volumes. Results demonstrate that distinct MCI subgroups can be empirically derived and reliably differentiated from a heterogeneous MCI sample, and that these profiles differ according to WML burden. Overall, findings suggest different underlying pathologies within MCI and contribute to our understanding of MCI subtypes.
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Knopman DS, Roberts RO, Geda YE, Boeve BF, Pankratz VS, Cha RH, Tangalos EG, Ivnik RJ, Petersen RC. Association of prior stroke with cognitive function and cognitive impairment: a population-based study. ACTA ACUST UNITED AC 2009; 66:614-9. [PMID: 19433661 DOI: 10.1001/archneurol.2009.30] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Defining the nature of the contribution of stroke to cognitive impairment remains challenging. OBJECTIVE To describe associations between stroke history, APOE genotype, and subtypes of mild cognitive impairment (MCI). METHODS We randomly selected residents from Olmsted County, Minnesota, aged 70 to 89 years on October 1, 2004, and invited eligible subjects without documented dementia to participate. Participants (n = 2050) were evaluated through an informant interview, a neurological evaluation, and neuropsychological testing. Neuropsychological testing included 9 tests to assess memory, attention, executive function, visuospatial cognition, and language. Subjects were diagnosed by consensus as cognitively normal or as having MCI (either amnestic or nonamnestic) or dementia. A history of stroke was obtained from the subjects and confirmed in their medical records. We computed the odds ratios (ORs) for a clinical diagnosis of MCI or for scoring in the lowest quartile on each cognitive domain. RESULTS There were 1640 cognitively normal subjects and 329 subjects with MCI: 241 with amnestic MCI and 88 with nonamnestic MCI. In fully adjusted models with only subjects without dementia, a history of stroke was associated with a higher OR of nonamnestic MCI (OR, 2.85; 95% confidence interval [CI], 1.61-5.04) than amnestic MCI (OR, 1.77; 95% CI, 1.14-2.74). A history of stroke was also associated with impaired function in each cognitive domain except memory. The association was strongest for attention and executive function (OR, 2.48; 95% CI, 1.73-3.53). APOE epsilon4 genotype was associated only with amnestic MCI and with impaired memory function. CONCLUSIONS In this population-based sample of persons without dementia, a history of stroke was particularly associated with nonamnestic MCI and impairment in nonmemory cognition. The APOE epsilon4 genotype was associated with memory impairment and amnestic MCI.
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Affiliation(s)
- David S Knopman
- Department of Neurology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
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Scherder E, Eggermont L, Swaab D, van Heuvelen M, Kamsma Y, de Greef M, van Wijck R, Mulder T. Gait in ageing and associated dementias; its relationship with cognition. Neurosci Biobehav Rev 2007; 31:485-97. [PMID: 17306372 DOI: 10.1016/j.neubiorev.2006.11.007] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Indexed: 10/23/2022]
Abstract
The focus of this review is on the close relationship between gait and cognition in ageing and associated dementias. This close relationship is supported by epidemiological studies, clinical studies of older people with and without dementia that focused on the intensity of the physical activity, clinical studies with older persons without dementia examining a relationship between gait and specific cognitive processes, and human and animal experimental studies examining a neural basis for such a relationship. Despite these findings, most studies with patients with dementia focus exclusively on the relationship between cognition and dementia, with relatively few addressing the relationship between gait and dementia. However, subtle disturbances in gait can be observed in ageing and in (preclinical) subtypes of dementia that are not known for prominent motor disturbances, i.e. Mild Cognitive Impairment, Alzheimer's Disease, vascular Cognitive Impairment No Dementia, Subcortical Ischaemic Vascular Dementia, Frontotemporal Mild Cognitive Impairment, and Frontotemporal Dementia, supporting a close relationship between gait and cognition. The relationship between gait and cognition is weakened by the few available intervention studies that examine the effects of walking on cognition in patients with (preclinical) dementia. These studies report equivocal results, which will be discussed. Finally, suggestions for future research will be made.
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Affiliation(s)
- Erik Scherder
- Institute of Human Movement Sciences, Rijksuniversiteit Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Selnes OA, Vinters HV. Vascular cognitive impairment. ACTA ACUST UNITED AC 2006; 2:538-47. [PMID: 16990827 DOI: 10.1038/ncpneuro0294] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 07/21/2006] [Indexed: 11/09/2022]
Abstract
Cognitive impairment commonly accompanies clinical syndromes associated with vascular disease of the brain. Because of evolving definitional criteria, however, the frequency of cognitive impairment attributable to cerebrovascular disease is difficult to determine. Dementia occurs in up to one-third of elderly patients with stroke, a subset of whom have Alzheimer's disease (AD) rather than a pure vascular dementia syndrome. In fact, pure vascular dementia has been shown to be uncommon in most large autopsy series. A mixed etiology of AD and cerebrovascular disease is thought to become more common with increasing age, although no clinical criteria for the diagnosis of AD with cerebrovascular disease are currently available. Epidemiological studies have implicated subcortical small-vessel disease as a risk factor for cognitive impairment and dementia, but the cognitive expression and clinical significance of MRI white matter changes in individual patients is difficult to establish. The frequency of specific neuropathologic features of vascular cognitive impairment depends largely on study inclusion criteria. Cerebral meningocortical microangiopathies with distinctive clinicopathological profiles are associated with dementia in both sporadic cases and familial syndromes. In patients with AD, the contribution of amyloid-beta protein to the degree of cognitive impairment has not been clearly defined.
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Affiliation(s)
- Ola A Selnes
- Cognitive Neuroscience Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205-1910, USA.
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Abstract
Cerebrovascular disease is increasingly recognized as a common cause of cognitive impairment and dementia in later life either alone or in conjunction with other pathologies, most often Alzheimer disease (AD). Progress in the field has been limited by difficulties in terminology; for example, use of the term dementia necessitates the presence of memory impairment, which is the norm in AD, but not in cognitive disorders associated with cerebrovascular disease. The term vascular cognitive impairment (VCI) has been proposed as an umbrella term to recognize the broad spectrum of cognitive, and indeed behavioral, changes associated with vascular pathology. It is characterized by a specific cognitive profile with predominantly attentional and executive impairments together with particular noncognitive features (especially depression) and a relatively stable course, at least in clinical trial populations. Subtypes of VCI have been proposed based on clinical and pathologic differences, including cortical, subcortical, strategic infarct, hypoperfusion, hemorrhagic, and mixed (with AD) type. Diagnostic criteria are emerging but require refinement and validation, especially for mixed dementias. There remain fundamental gaps in our understanding of pathophysiology, predicting prognosis and outcome, and in therapeutics. Clinical trials to date, mainly in populations selected using currently accepted criteria for vascular dementia, have generally been disappointing. A relatively modest cognitive benefit of agents such as nimodipine, memantine, and cholinesterase inhibitors has been reported, although the clinical significance of these improvements remains to be established. Further studies, focusing on particular subtypes of VCI and involving subjects at earlier stages of the disease, are required. The aim of this article is to review the concept of VCI in terms of the evidence base surrounding diagnosis, clinical features, pathophysiology, and management and to make some recommendations regarding further research in the area. It begins with a discussion on the historical background, which is important to understand the different and somewhat confusing terminology that currently exists in the field.
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Affiliation(s)
- John T O'Brien
- Institute for Ageing and Health, Wolfson Research Centre, Newcastle-upon-Tyne, UK. j.t.o'
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27
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Abstract
Cerebrovascular disease is an important cause of cognitive Impairment and dementia in elderly patients. This review highlights the challenges involved in examining the role of cerebrovascular disease In dementia, areas in which consensus is emerging, and an operational framework for clinicians. Two important challenges exist. First, there is no accepted neuropathologic scheme for quantitating cerebrovascular disease In cognitive disturbances. Second, agreement on clinical definitions of vascular dementia is incomplete. Despite the barriers posed by these 2 deficiencies, many consistencies in the clinical, imaging, epidemiological, and neuropathologic aspects of cerebrovascular disease and cognitive impairment have been Identified. Different levels of cerebrovascular disease related to cognitive impairment can be suggested on clinical and Imaging grounds. The overlap between cerebrovascular disease and Alzheimer disease produces a disorder that might be amenable to therapeutic approaches based on either mechanism.
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Affiliation(s)
- David S Knopman
- Department of Neurology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
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Jokinen H, Kalska H, Mäntylä R, Pohjasvaara T, Ylikoski R, Hietanen M, Salonen O, Kaste M, Erkinjuntti T. Cognitive profile of subcortical ischaemic vascular disease. J Neurol Neurosurg Psychiatry 2006; 77:28-33. [PMID: 16361588 PMCID: PMC2117424 DOI: 10.1136/jnnp.2005.069120] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Subcortical ischaemic vascular disease (SIVD) is a subtype of vascular cognitive impairment characterised by extensive white matter lesions and multiple lacunar infarcts. Radiologically defined diagnostic criteria for SIVD have been introduced, but only a few studies have presented empirical data on its clinical and cognitive features. The aim of this study is to describe in detail the neuropsychological characteristics of patients with SIVD from a large well defined stroke cohort. METHODS A sample of 323 consecutive patients with ischaemic stroke, aged 55-85 years, was investigated using neuropsychological examination and magnetic resonance imaging (MRI). Patients fulfilling the MRI criteria of SIVD (n = 85) were compared to the other stroke patients (n = 238) and to normal control subjects (n = 38). RESULTS Cognitive performance of the SIVD group was inferior to that of the normal control group throughout all domains. As compared to the other stroke patients, the SIVD group performed significantly worse in tests measuring executive functions and delayed memory recall. Adjusting for depression had no effect on these results. Instead, after controlling for medial temporal lobe atrophy, the differences disappeared for delayed memory but remained significant for executive functions. CONCLUSION Executive deficits are the most prominent cognitive characteristic associated with SIVD. Patients with SIVD also exhibit subtle deficits in delayed memory, which is explained in part by medial temporal lobe atrophy. Cognitive and mood changes seem to be parallel but independent processes related to SIVD. The results support the concept of SIVD as a separate clinical entity.
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Affiliation(s)
- H Jokinen
- Department of Psychology, University of Helsinki, Helsinki, Finland.
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De Reuck J, De Clerck M, Van Maele G. Vascular cognitive impairment in patients with late-onset seizures after an ischemic stroke. Clin Neurol Neurosurg 2005; 108:632-7. [PMID: 16316720 DOI: 10.1016/j.clineuro.2005.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Revised: 10/10/2005] [Accepted: 10/15/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive impairment and seizures are both common conditions in patients with cerebrovascular disease. PURPOSE The present study investigates whether the occurrence of late-onset seizures, following an ischemic stroke, contributes to vascular cognitive impairment. PATIENTS AND METHODS The mean Mini-Mental State Examination (MMSE) and the median modified Rankin (mR) scores were compared between 125 patients who developed late-onset seizures (66 with a single seizure and 59 with repeated seizures or epilepsy) following an ischemic stroke and 125 patients who did not during, at least, a 2-year follow-up. RESULTS There were no differences in age, gender, etiology and degree of neurological impairment on admission for their stroke between the groups with and without seizures. Although the mean MMSE score was similar between both groups the median mR score was significantly higher in the seizure patients. Comparing the patients with a single seizure to the non-seizure ones showed the same results. On the other hand, comparison of the patients with epilepsy to the non-seizure group revealed, in addition to the higher median mR score, a significantly lower mean MMSE score in the former group. CONCLUSION Repeated seizures following an ischemic stroke promote vascular cognitive impairment.
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Affiliation(s)
- Jacques De Reuck
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
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Talelli P, Ellul J, Terzis G, Lekka NP, Gioldasis G, Chrysanthopoulou A, Papapetropoulos T. Common carotid artery intima media thickness and post-stroke cognitive impairment. J Neurol Sci 2004; 223:129-34. [PMID: 15337613 DOI: 10.1016/j.jns.2004.05.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Revised: 05/05/2004] [Accepted: 05/05/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Acute stroke and other forms of cerebrovascular disease are well-recognized causes of cognitive impairment. Common carotid artery intima media thickness (CCA-IMT) has been associated with certain forms of cerebrovascular disease, but its association with cognitive impairment of vascular origin has not been elucidated. The purpose of this study was to investigate whether CCA-IMT is associated with cognitive impairment 1 year after an acute ischemic stroke. METHODS A total of 171 consecutive patients with the first ever stroke (mean age 66+/-11.5, 41% female) underwent carotid ultrasonography during hospitalization. Demographic data, vascular risk factors and presenting stroke features were also recorded. One year later, patients' cognitive performance and depression were assessed using the Mini-Mental State Examination (MMSE), and the Montgomery Asberg Depression Rating Scale (MADRS). RESULTS Cognitive impairment (MMSE score<24) was found in 67 (39%) of the 171 patients. CCA-IMT was significantly associated with cognitive impairment, and this association remained unchanged (OR 1.94; 95% CI 1.19-3.18) after adjustment for demographic data, vascular risk factors, stroke features, other carotid ultrasonography measurements and depression. Older age, low education level, large hemispheric lesions, hyperdense carotid plaques and depression were also independently associated with post-stroke cognitive impairment. CONCLUSIONS In this study, CCA-IMT was independently associated with cognitive impairment 1 year after an acute ischemic stroke, and thus, it might help with the screening of stroke patients at risk of cognitive impairment.
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Affiliation(s)
- P Talelli
- Department of Neurology, University Hospital of Patras, P.O. Box 1045, 26500 Rio, Patras, Greece
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Vega E, Gómez-Villalobos MDJ, Flores G. Alteration in dendritic morphology of pyramidal neurons from the prefrontal cortex of rats with renovascular hypertension. Brain Res 2004; 1021:112-8. [PMID: 15328038 DOI: 10.1016/j.brainres.2004.06.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2004] [Indexed: 10/26/2022]
Abstract
We have studied, in the rat, the dendritic morphological changes of the pyramidal neurons of the medial part of the prefrontal cortex induced by the chronic effect of high blood pressure. Renovascular hypertension was induced using a silver clip on the renal artery by surgery. The morphology of the pyramidal neurons from the medial part of the prefrontal cortex was investigated in these animals. The blood pressure was measured to confirm the increase in the arterial blood pressure. After 16 weeks of increase in the arterial blood pressure, the animals were sacrificed by overdoses of sodium pentobarbital and perfused intracardially with a 0.9% saline solution. The brains were removed, processed by the Golgi-Cox stain method and analyzed by the Sholl method. The dendritic morphology clearly showed that the hypertensive animals had an increase (32%) in the dendritic length of the pyramidal cells with a decrease (50%) in the density of dendritic spines when compared with sham animals. The branch-order analysis showed that the animals with hypertension exhibit more dendritic arborization at the level of the first to fourth branch order. This result suggests that renovascular hypertension may in part affect the dendritic morphology in this limbic structure, which may implicate cognitive impairment in hypertensive patients.
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Affiliation(s)
- Elenia Vega
- Escuela de Biología, Universidad Autónoma de Puebla, Puebla, México
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Mok VCT, Wong A, Lam WWM, Fan YH, Tang WK, Kwok T, Hui ACF, Wong KS. Cognitive impairment and functional outcome after stroke associated with small vessel disease. J Neurol Neurosurg Psychiatry 2004; 75:560-6. [PMID: 15026497 PMCID: PMC1739014 DOI: 10.1136/jnnp.2003.015107] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Although stroke associated with small vessel disease (SSVD) can induce both motor and cognitive impairment, the latter has received less attention. We aimed to evaluate the frequency of the varying severity levels of cognitive impairment, the determinants of severe cognitive impairment, and the association of cognitive impairment with functional outcome after SSVD. METHODS Consecutive patients admitted to hospital because of SSVD were assessed at 3 months after stroke. We performed a semi-structured clinical interview to screen for cognitive symptoms. Severity of cognitive symptoms was graded according to the Clinical Dementia Rating Scale (CDR). Performance on psychometric tests (Mini-Mental State Examination, Alzheimer's Disease Assessment Scale (cognition subscale), Mattis Dementia Rating Scale (initiation/perseverence subscale; MDRS I/P)) of patients of different CDR gradings was compared with that of 42 healthy controls. Basic demographic data, vascular risk factors, stroke severity (National Institute of Health Stroke Scale; NIHSS), pre-stroke cognitive decline (Informant Questionnaire on Cognitive Decline in the Elderly; IQCODE), functional outcome (Barthel index; BI), Instrumental Activities Of Daily Living; IADL), and neuroimaging features (site of recent small infarcts, number of silent small infarcts, white matter changes) were also compared among the groups. Regression analyses were performed to find predictors of severe cognitive impairment and poor functional outcome. RESULTS Among the 75 included patients, 39 (52%) complained of cognitive symptoms. The number of patients in each CDR grading was as follows: 39 (52%) had a CDR of 0, 26 (34.7%) had a CDR of 0.5, 10 (13.3%) had a CDR of > or =1. Pre-stroke IQCODE and previous stroke predicted CDR> or =1. The NIHSS was associated with more impaired BI. The NIHSS and MDRS I/P contributed most to impaired IADL. CONCLUSIONS Half of the patients with SSVD complained of varying severity of cognitive problems 3 months after stroke. Pre-stroke cognitive decline and previous stroke predict severe cognitive impairment post stroke. Stroke severity and executive dysfunction contribute most to a poor functional outcome.
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Affiliation(s)
- V C T Mok
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Supprian T, Kessler H, Retz W, Rösler M, Grunwald I, Reith W, Falkai P. [White matter alterations in neurodegenerative and vascular dementia]. Radiologe 2003; 43:543-51. [PMID: 12955217 DOI: 10.1007/s00117-003-0916-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Due to a significant overlap of the two syndromes, differentiation of degenerative dementia of the Alzheimer-type from vascular dementia may be difficult even when imaging studies are available. White matter changes occur in many patients suffering from Alzheimer's disease. Little is known about the impact of white matter changes on the course and clinical presentation of Alzheimer's disease. High sensitivity of MRI in the detection of white matter alterations may account for over-diagnosing vascular dementia. The clinical significance of white matter alterations in dementia is still a matter of debate. The article reviews current concepts about the role of white matter alterations in dementia.
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Affiliation(s)
- T Supprian
- Arbeitsgruppe Gerontopsychiatrie, Universitäts-Nervenklinik Homburg (Saar).
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