Association of White Matter Integrity and Cognitive Functions in Patients With Subcortical Silent Lacunar Infarcts

Chen, Yaojing; Wang, Ailin; Tang, Jinfu; Wei, Dongfeng; Chen, Kewei; Wang, Yongyan; Zhang, Zhanjun

doi:10.1161/strokeaha.115.008998

Cited by 37 publications

(34 citation statements)

References 13 publications

(16 reference statements)

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“…Patients with ESRD have lower FA and higher MD values[6, 10–13], which are generally associated with poorer cognitive function[8, 9, 22, 23]. Moreover, improvement in FA and MD is associated with an improvement in cognition[24].…”

Section: Discussionmentioning

confidence: 99%

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Cognitive Function and White Matter Changes Associated with Renal Transplantation

Gupta

Lepping

et al. 2016

Am J Nephrol

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Background: End-stage renal disease (ESRD) is a disease with an aging population and a high prevalence of cognitive impairment affecting quality of life, health care costs and mortality. Structural changes in the brain with decreased white matter integrity have been observed in ESRD. Understanding the changes in cognition and associated changes in brain structure after renal transplantation can help define the mechanisms underlying cognitive impairment in ESRD. Methods: We conducted a prospective, observational cohort study in ESRD patients listed for renal transplantation and followed them post-transplantation. We assessed their cognitive function with a battery of neuropsychological tests and brain white matter integrity with diffusion tensor imaging (DTI) both before transplant and 3 months after transplant. Results: Eleven patients, aged 56.5 ± 10.7 years, completed the study. Cognitive measures of memory and executive function improved after the transplant, specifically on tests of logical memory I (p = 0.004), logical memory II (p = 0.003) and digit symbol (p < 0.0001). DTI metrics also improved post the transplant with an increase in fractional anisotropy (p = 0.01) and decrease in mean diffusivity (p = 0.004). These changes were more prominent in tracts associated with memory and executive function. Conclusions: Cognitive function, particularly memory and executive function, improve post the transplant with concurrent improvements in white matter integrity in tracts associated with memory and executive function. These data suggest that abnormalities in cognition and brain structure seen in the ESRD population are at least partially reversible.

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Section: Discussionmentioning

confidence: 99%

“…Lower FA and higher MD values are associated with impaired cognition[8, 9]. Patients with ESRD have lower FA and higher MD values[6, 10–13].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Function and White Matter Changes Associated with Renal Transplantation

Gupta

Lepping

et al. 2016

Am J Nephrol

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“…Fern et al demonstrated that tract-specific damage of WM and region-specific lesions and network disruption accompanied cognitive declines and eventually led to dementia. DTI of patients with lacunar infarcts reveal decreased FA and increased MD across several WM regions either close to or relatively far from lesions, implying that WM damage not only influences nearby areas, but also extends across considerable distances (Chen et al, 2015b). Lunven et al directed a prospective, longitudinal study that measured microstructural markers of neglect restoration after ischemia in the MCA territory (Lunven et al, 2015).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

White matter injury in ischemic stroke

Wang

Liu

Hong

et al. 2016

Progress in Neurobiology

221

206

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Stroke is one of the major causes of disability and mortality worldwide. It is well known that ischemic stroke can cause gray matter injury. However, stroke also elicits profound white matter injury, a risk factor for higher stroke incidence and poor neurological outcomes. The majority of damage caused by stroke is located in subcortical regions and, remarkably, white matter occupies nearly half of the average infarct volume. Indeed, white matter is exquisitely vulnerable to ischemia and is often injured more severely than gray matter. Clinical symptoms related to white matter injury include cognitive dysfunction, emotional disorders, sensorimotor impairments, as well as urinary incontinence and pain, all of which are closely associated with destruction and remodeling of white matter connectivity. White matter injury can be noninvasively detected by MRI, which provides a three-dimensional assessment of its morphology, metabolism, and function. There is an urgent need for novel white matter therapies, as currently available strategies are limited to preclinical animal studies. Optimal protection against ischemic stroke will need to encompass the fortification of both gray and white matter. In this review, we discuss white matter injury after ischemic stroke, focusing on clinical features and tools, such as imaging, manifestation, and potential treatments. We also briefly discuss the pathophysiology of WMI and future research directions.

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“…Until recently, this finding had been considered a benign accompaniment to aging. 1 However, accumulating evidences have shown that SBI is a clinically important precursor lesion of many adverse health outcomes, including cognitive decline 2 and clinical stroke. 3 SBI includes 2 subtypes, lacunar type (silent lacunar infarction [SLI]) and nonlacunar type.…”

mentioning

confidence: 99%

Insulin Resistance Is a Risk Factor for Silent Lacunar Infarction

Lee

Shin

Yun

et al. 2016

Stroke

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Background and Purpose— This study aims to investigate the association between insulin resistance (IR) and silent lacunar infarction (SLI) in healthy adults. Methods— We recruited 2326 healthy Korean adults who took health checkups, including a brain magnetic resonance imaging. SLI was defined as an infarction measuring 0.3 to 1.5 cm in diameter that was localized in the territory of perforating branches of cerebral arteries, as seen in the brain magnetic resonance imaging. The homeostasis model assessment–estimated insulin resistance index was used for IR estimation, and the cutoff value for its diagnosis for Koreans was 2.56. Results— The mean age of the study population was 56.2 years (range, 40–79 years), and 1279 subjects (55.0%) were male. The prevalence of SLI and IR was 8.1% and 18.1%, respectively. In multivariate logistic analysis, after adjusting for traditional SLI-associated risk factors, IR was positively associated with the prevalence of SLI (adjusted odds ratio, 1.69; 95% confidence interval, 1.16–2.46). The proportion of subjects with multiple SLI lesions (≥2) was also higher in the IR (+) group than that in the IR (−) group (4.3% versus 1.7%; P <0.001). In ordered logistic regression, IR was positively associated with an increase in SLI severity (adjusted odds ratio, 1.76; 95% confidence interval, 1.21–2.56). Conclusions— IR is an independent risk factor of SLI presence and its severity in Koreans. Whether improvement of IR might prevent SLI occurrence needs to be addressed by clinical trials.

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Association of White Matter Integrity and Cognitive Functions in Patients With Subcortical Silent Lacunar Infarcts

Cited by 37 publications

References 13 publications

Cognitive Function and White Matter Changes Associated with Renal Transplantation

Cognitive Function and White Matter Changes Associated with Renal Transplantation

White matter injury in ischemic stroke

Insulin Resistance Is a Risk Factor for Silent Lacunar Infarction

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