Objective. to determine the early signs of structural changes in brain white matter in small vessel disease associated with arterial hypertension and exposure to ionizing radiation using DTI-MRI. Materials and methods. 45 patients (mean age (57.56 ± 6.34) years) with small vessel disease (SVD) associated with arterial hypertension (AH) were examined: group I – 20 patients, participants of liquidation of the accident at the Chornobyl nuclear power plant (Chornobyl clean-up workers); group II – 25 patients not exposed to ionizing radiation. MRI was performed on an Ingenia 3T tomograph («Philips»). The fractional anisotropy (FA) was determined in the main associative and commissural pathways, periventricular prefrontal areas (fasciculus fronto-occipitalis superior / anterior – f. FO ant., corona radiata anterior – CR ant.) and semioval centers (SC). Results. No signs of cerebral cortex or brain white matter (WM) atrophy, intracerebral microhemorrhages, and widespread areas of leukoaraiosis consolidation were observed in the examined patients. In the Chornobyl clean-up workers a larger number of foci of subcortical leukoaraiosis was visualized (80 %) on MRI images including multiple – 8 (40 %), > 0.5 cm – 10 (50 %), with signs of consolidation – 5 (25 %). The results of the FA analysis in semioval centers showed its significant decrease in the patients of groups I and II (p < 0,007), regardless of the presence or absence of visual signs of subcortical leukoaraiosis (ScLA) (III gr.: 253–317, p < 0.00001; IV gr.: 287– 375, p < 0.001). FA indicators in f. FO ant. and CR ant. in the patients of groups I and II differed insignificantly but were substantially lower than controls (p < 0.05). FA was significantly lower, compared to reference levels, in visually unchanged f. FO ant. (0.389–0.425; p = 0.015) and CR ant. (0.335–0.403; p = 0.05). In patients with AH-associated SVD of middle age, regardless of the effects of ionizing radiation, no significant changes in FA in the main WM associative and commissural pathways were found (p > 0.05). Conclusions. DTI-MRI allows to detect early signs of structural changes in the white matter of the brain – a significant decrease in fractional anisotropy indicators in visually unchanged periventricular and subcortical areas. The main associative and commissural pathways of the brain remain intact in the absence of widespread consolidated foci of leukoaraiosis and lacunar infarctions. The negative impact of ionizing radiation on the course of SVD associated with arterial hypertension is manifested by more active processes of WM disorganization: the prevalence and tendency to the consolidation of periventricular and subcortical leukoaraiosis foci, a significant FA decrease in semioval centers. Key words: DTI, MRI, fractional anisotropy, arterial hypertension, small vessel disease, white matter of the brain, ionizing radiation. Key words: cirrhosis, hepatobiliary system, clean-up workers of Chornobyl NPP accident, retrospective study.
Background. The growing number of patients with dementia in aging population of developed countries significantly increases the relevance of differential diagnosis of cognitive impairment and age-associated cognitive disorders. The purpose of the study was to determine the criteria for physiological changes in cognitive status and diffusion processes in brain’s white matter in healthy middle-aged and elderly people. Material and methods. Thirty-nine healthy middle-aged (45–59 years, n = 19) and elderly patients (60–75 years, n = 20) were examined. Neuropsychological testing was performed using the following scales: Montreal Cognitive Assessment, Mini-Mental State Examination, Frontal Assessment Battery, Semantic Verbal Fluency (SVF) and Phonemic Verbal Fluency (PVF). Molecular diffusion in brain’s white matter was investigated by diffusion tensor imaging (Ingenia 3.0T, Philips). Results. Moderate positive correlations were found between age and the Frontal Assessment Battery score (rs = –0.443), memory (rs = –0.444) and executive function (rs = –0.542). Cognitive functions in middle-aged and elderly patients didn’t differ in cognitive domains of naming (II), memory (III), language (VIII), delayed reproduction (X), orientation (XI), semantic and phonemic verbal fluency. At the same time, differences in attention (IV, VI, AIS: p = 0.038; 0.043; < 0.001), language (VII, LIS: p < 0.001), abstraction (IX: p = 0.008) and visuospatial function (VIS: p = 0.002) were significant. Physiolo-gical age-related changes of molecular diffusion in the white matter of the cerebral hemispheres are characterized by a decrease of 21.0–37.0 % (p = 0.02 — < 0.001) in anisotropic and an increase of 16.3–29.5 % (p < 0.001) in free diffusion of water molecules in the conductive tracts and beyond them.
Background. The urgency of cerebral small vessel disease (cSVD) in modern neurology is considered mainly in terms of the development of vascular dementia and early diagnosis of Alzheimer’s disease. Minimal changes in MRI images and indistinct cognitive disorders in SNAMA-type cSVD (sporadic non-amyloid microangiopathy) last for a long time until they manifest as acute cerebrovascular disorders and/or significant mental deficits. However, clinical and neuroimaging criteria for early diagnosis of the disease have not been established yet, and the nature of the correlations between the indicators of neuropsychological and multiparametric MRI studies has not been clarified. Purpose – to develop criteria for early diagnosis of SNAMA cerebrovascular disease in middle-aged patients using neuropsychological studies and high-field multiparametric MRI. Materials and methods. The study enrolled 34 middle-aged patients (52.5 ± 10.8) with hypertension of stage 1–2, stage I–II and cSVD (women – 11 (32.4%), men – 23 (67.6%)). The control group (19 healthy individuals) was identical in age, gender and total duration of education. MRI (3T) was performed in the following modes: T1-2WI, DWI, 3D Brain FLAIR SHC, 3D tra, VEN BOLD, DTI medium iso SENSE. Neuropsychological studies were performed using the MoSA questionnaire evaluating the EIS, VIS, AIS, LIS, MIS, OIS domains. Results and discussion. We developed and introduced a modified scoring system for determining the severity of the burden of cerebral small vessels disease (BcSVDearly) in clinical practice. Among the early visual MRI markers, the expansion of the perivascular spaces was dominated in 27 (79.4%) of participants. A minor increase in Σ BcSVDearly to 6–7 points was found in 10 (29.4%) patients. The age norm (0–4 points) corresponded to the indicators of Σ BcSVDearly 23 out of 34 (67.6%) in the main group. Additional evidence of the disease was obtained by DTI MRI. The most significant decrease in FA was recorded in belt fibers (Δ: up to – 31.4%) and semioval centers (Δ: up to – 33.6%), the largest increase in MD was recorded in hooked bundles (Δ: up to 24.4%); right prefrontal, orbitofrontal and parietal areas (Δ up to 28.0%). According to the MoSA scale, moderate cognitive impairment was detected in 29 of 34 (85.3%) patients with a significant decrease in scores in the domains of EIS, VIS, LIS and AIS (p <0.001). The severity of early clinical manifestations of cSVD (non-amnestic polydomain moderate disorders of attention, speech, visual-spatial and executive cognitive functions) has been found to be moderately / markedly correlated with THMS, MD (positive) and FA (negative).Conclusions. We determined early visual signs of cSVD associated with arterial hypertension: dilated perivascular spaces, hyperintensity of the periventricular deep white matter of the brain, decrease by 9–33.6% of FA coefficient and increase by 20.8% – 28.0% MD. Moderate correlations between neuropsychological and neuroimaging studies have been demonstrated.
Early diagnosis of cerebral small vessels disease (CSVD) in the elderly in the elderly is a daunting task due to the similarity of its clinical and neuroimaging manifestations to age-related changes and high comorbidity with neurodegenerative diseases. The aim of the work is to determine the features of early neuropsychological and neuroimaging manifestations of CSVD, which was first diagnosed in old age. Material and methods. 37 elderly patients (EP: 60-75 years) with arterial hypertension (AH) st. 1-2, stage I-II and CSVD (women – 17 (45.9%), men – 220 (54.1%) were examined. Control groups: KGEP – 20 practically healthy elderly people and a group of middle-aged patients (ME – 44-59 years) with AH st. 1-2, stage I-II and CSVD are identical in age, gender and general duration of education. Total Cerebral volume blood flow (TcVBF) was determined using duplex ultrasound (USDS). MRI (3T) was performed in the following modes: T1-2WI, DWI, 3D Brain FLAIR SHC, 3D tra, VEN BOLD, DTI medium iso SENSE. Neuropsychological studies were performed using: MoCA questionnaire with evaluation of EIS, VIS, AIS, LIS, MIS, OIS domains; MMSE; SSR and PhSR (Semantic and Phonetic Speech Rate); FAB (Fontal Assessment Battery). Results and discussion. Using the modified scoring system for determining the severity of the burden of cerebral small vessels disease (BCSVDearly), it was found that the only difference between patients with clinical manifestations of the pathological process in middle and old age is the presence of lacunar infarctions in 16.2% of elderly patients. The relative changes in pre-visual markers of CSVD (DTI - MRI) in older patients were less pronounced than in middle-aged patients (FA: up to -24.1% in fibers and up to -18.6% in ROI; MD: up to +14, 9% in fibers and + 18.2% in ROI). There are also significant differences in the influence of diffusion disorders in the white matter (WM) of the brain on the cognitive status of patients with CSVD of middle-aged and elderly (emphasis on the number and rank of correlations). In the group of middle-aged patients, 270 out of 280 (96.4%) possible correlations were identified, including 22.1% (60) of those classified as noticeable (≥ + 0.5 / ≤ -0.5). In older subjects, the proportion of established moderate correlations reached only 21.4%, with a minimum negative rs = -0.45. Conclusion. The principal differences of the clinical and neuroimaging manifestation of CSVD in the elderly were determined: the relative decrease in the scores of cognitive functions to 73.0% (against 91.2% in the ME group); the presence of LI in the list of visual signs of CSVD; less pronounced, compared to ME, changes in pre-visual (diffusion) indicators of the state of deep WM; no correlations for MoCA, BCSVDearly, FA and MD domains.
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