Apolipoprotein E-ε4 polymorphism and cognitive dysfunction after carotid endarterectomy

Heyer, Éric; Mergeche, Joanna L.; Stern, Yaakov; Malone, Hani; Bruce, Samuel S.; Ward, Justin T.; Connolly, E. Sander

doi:10.1016/j.jocn.2013.04.009

Cited by 10 publications

(1 citation statement)

References 34 publications

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“…The default mode network is also a brain system involved in memory that is affected by Alzheimer's disease through amyloid deposition ( Buckner et al, 2005 ), hence lesions may be affecting an already vulnerable network. Apolipoprotein E-epsilon4 polymorphism, a genetic mutation associated with amyloid deposition, is associated with cognitive decline in Alzheimer's but also increased risk of CEA related cognitive decline ( Heyer et al, 2014 ). The occipital cluster appears to be located at the border zone between the MCA and PCA territories and likely still represents an embolus location in the very distal MCA territory ( Kansagra and Wong, 2008 ).…”

Section: Discussionmentioning

confidence: 99%

Convergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization

Rosen

Soman

Bhat

et al. 2018

NeuroImage: Clinical

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Carotid revascularization (endarterectomy, stenting) prevents stroke; however, procedure-related embolization is common and results in small brain lesions easily identified by diffusion weighted magnetic resonance imaging (DWI). A crucial barrier to understanding the clinical significance of these lesions has been the lack of a statistical approach to identify vulnerable brain areas. The problem is that the lesions are small, numerous, and non-overlapping. Here we address this problem with a new method, the Convergence Analysis of Micro-Lesions (CAML) technique, an extension of the Anatomic Likelihood Analysis (ALE). The method combines manual lesion tracing, constraints based on known lesion patterns, and convergence analysis to represent regions vulnerable to lesions as probabilistic brain atlases. Two studies were conducted over the course of 12 years in an active, vascular surgery clinic. An analysis in an initial group of 126 patients at 1.5 T MRI was cross-validated in a second group of 80 patients at 3T MRI. In CAML, lesions were manually defined and center points identified. Brains were aligned according to side of surgery since this factor powerfully determines lesion distribution. A convergence based analysis, was performed on each of these groups. Results indicated the most consistent region of vulnerability was in motor and premotor cortex regions. Smaller regions common to both groups included the dorsolateral prefrontal cortex and medial parietal regions. Vulnerability of motor cortex is consistent with previous work showing changes in hand dexterity associated with these procedures. The consistency of CAML also demonstrates the feasibility of this new approach to characterize small, diffuse, non-overlapping lesions in patients with multifocal pathologies.

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Section: Discussionmentioning

confidence: 99%