We could establish normal values for aortic isthmus diameters in late gestation from a coronal view and identify even minimal changes in aortic isthmus dimensions and morphology in pathological conditions.

ObjectiveThe severity of cerebral small vessel disease (SVD) is assessed through neuroimaging findings, including hypertensive arteriopathy (HA)-SVD and cerebral amyloid angiopathy (CAA)-SVD. HA-SVD and CAA-SVD have been collectively estimated as total scores: the HA-SVD and CAA-SVD scores, respectively. Previous reports suggest that HA-SVD scores are associated with cognitive function; however, the relationship between CAA-SVD scores and cognitive function remains unclear. Therefore, we examined the association between CAA-SVD scores and cognitive function. Furthermore, we developed a modified CAA-SVD score considering cortical microinfarcts and posterior dominant white matter hyperintensities, which are imaging findings of CAA, and examined the association between these scores and cognitive function in the same patient group.DesignProspective study.SettingSingle centre study from a memory clinic.ParticipantsSubjects were diagnosed with mild cognitive impairment (MCI) or mild dementia in our memory clinic between February 2017 and July 2019 and underwent clinical dementia rating scale and brain MRI assessment. A total of 42 patients (aged 75.3±9.12 years) were registered prospectively.Primary and secondary outcome measuresWe evaluated intellectual function, memory, frontal lobe function and constructional ability. Furthermore, the relationship between each score and cognitive function was examined.ResultsThe CAA-SVD score showed significant associations with cognitive function (R2=0.63, p=0.016), but the HA-SVD score did not (R2=0.41, p=0.35). The modified CAA-SVD score was also significantly associated with cognitive function (R2=0.65, p=0.008).ConclusionCognitive function is associated with the CAA-SVD score, and more efficiently with the modified CAA-SVD score, in memory clinic patients. Although we have not validated the weighting of the modified CAA-SVD score, these scores can be a predictor of cognitive deterioration in patients with MCI and mild dementia.

Background/Aims: Constructional apraxia (CA) is usually diagnosed by having patients draw figures; however, the reported assessments only evaluate the drawn figure. We designed a new assessment battery for CA (the Mie Constructional Apraxia Scale, MCAS) which includes both the shape and drawing process, and investigated its utility against other assessment methods. Methods: We designed the MCAS, and evaluated inter- and intrarater reliability. We also investigated the sensitivity, specificity, and positive and negative predictive values in dementia patients, and compared MCAS assessment with other reported batteries in the same subjects. Results: Moderate interrater reliability was shown for speech therapists with limited experience. Moderate to substantial intrarater reliability was shown several weeks after initial assessment. When cutoff scores and times were set at 2/3 points and 39/40 s, sensitivity and specificity were 77.1 and 70.4%, respectively, with positive and negative predictive values of 80.0 and 66.7%, respectively. Dementia patients had significantly worse scores and times for Necker cube drawing than an elderly control group on the MCAS, and on other assessments. Conclusions: We conclude that the MCAS, which includes both the assessment of the drawn Necker cube shape and the drawing process, is useful for detecting even mild CA.

ObjectivesCerebral microbleeds (CMBs) are often observed in memory clinic patients. It has been generally accepted that deep CMBs (D‐CMBs) result from hypertensive vasculopathy (HV), whereas strictly lobar CMBs (SL‐CMBs) result from cerebral amyloid angiopathy (CAA) which frequently coexists with Alzheimer's disease (AD). Mixed CMBs (M‐CMBs) have been partially attributed to HV and also partially attributed to CAA. The aim of this study was to elucidate the differences between SL‐CMBs and M‐CMBs in terms of clinical features and regional distribution.MaterialsWe examined 176 sequential patients in our memory clinic for clinical features and CMB location using susceptibility‐weighted images obtained on a 3T‐MRI. The number of lobar CMBs in SL‐CMBs and M‐CMBs was counted in each cerebral lobe and their regional density was adjusted according to the volume of each lobe.ResultsOf the total 176 patients, 111 patients (63.1%) had CMBs. Within the patients who had CMBs, M‐CMBs were found in 54 patients (48.6%), followed by SL‐CMBs in 35 (31.5%) and D‐CMBs in 19 (17.1%). The SL‐CMB group showed a significantly higher prevalence of family history of dementia, whereas the M‐CMB group showed an increasing trend toward hypertension and smoking. The prevalence of AD was significantly higher in the SL‐CMBs group, whereas the prevalence of AD with cerebrovascular disease was higher in the M‐CMBs group. The regional density of lobar CMBs was significantly higher in the occipital lobe in the M‐CMB group, whereas the SL‐CMB group showed higher regional density between regions an increasing tendency in the parietal and occipital lobe.ConclusionThe between‐group differences in clinical features and regional distribution indicate there to be an etiological relationship of SL‐CMBs to AD and CAA, and M‐CMBs to both HV and CAA.

Abstract.Background: Lobar microbleeds (MBs) and cortical microinfarct (CMI) are caused by cerebral amyloid angiopathy in the elderly and increase in number in Alzheimer's disease. Objective: The aim of this study is to elucidate the effects of lobar MBs and CMIs on cognitive function. Methods: The subjects were outpatients who visited the memory clinic of Mie University Hospital. Among 120 subjects, 109 patients fulfilled the inclusion criteria. We quantitatively estimated MBs and CMIs using double inversion recovery and 3D FLAIR images of 3T MRI. Neuropsychological assessments included intellectual, memory, constructional, and frontal lobe function. Results: Of the 109 patients, MBs and CMIs were observed in 68 (62%) and 17 (16%) subjects, respectively. Of the 68 patients with MBs, lobar MBs were found in 28, deep MBs in 8 and mixed MBs in 31. In each age group, the number of MBs increased in patients with CMI (CMI+ group) than those without CMI (CMI-group), and MBs and CMIs additively decreased MMSE scores. In psychological screens, the MBs+ group with more than 10 MBs showed significantly lower scores of category-and letter-WF than MB-group. The CMI+ group showed significantly worse scores than CMI-group in Japanese Raven's coloured progressive matrices, Trail Making Test-A, category-and letter-word fluency and copy and drawing of figures. Conclusion: Lobar MBs and CMIs in the elderly frequently coexisted with each other and additively contributed to cognitive impairment, which is mainly predisposed to frontal lobe function.