Blood–Brain Barrier Permeability Abnormalities in Vascular Cognitive Impairment

Abstract

Background and Purose Disruption of the blood-brain barrier (BBB) has been proposed to be important in vascular cognitive impairment (VCI). Increased cerebrospinal fluid (CSF) albumin and contrast-enhanced MRI provide supporting evidence, but quantification of the BBB permeability in patients with VCI is lacking. Therefore, we acquired dynamic contrast-enhanced MRI (DCEMRI) to quantify BBB permeability in VCI. Method We studied 60 patients with suspected VCI. They had neurological and neuropsychological testing, permeability measurements with DCEMRI and lumbar puncture to measure albumin index (Qalb). Patients were separated clinically into subcortical ischemic vascular disease (SIVD), multiple and lacunar infarcts (MI/LAC), and leukoaraiosis (LA). Twenty volunteers were controls for the DCEMRI studies, and control CSF was obtained from 20 individuals undergoing spinal anesthesia for non-neurological problems. Results Thirty-six patients were classified as SIVD, 8 as MI/LAC and 9 as LA. The Qalb was significantly increased in the SIVD group compared to 20 controls. Permeabilities for the VCI patients measured by DCEMRI were significantly increased over controls (p<0.05). Patient age correlated with neither the BBB permeability nor Qalb. Highest Qalb values were seen in SIVD group (p<0.05), and were significantly increased over MI/LAC. Ki values were elevated over controls in SIVD, but were similar to MI/LAC. Conclusions There was abnormal permeability in white matter in patients with SIVD as shown by DCEMRI and Qalb. Future studies will be needed to determine the relationship of BBB damage and development of WMHs.

White Matter Hyperintensities Predict Low Frequency Hearing in Older Adults

“…There is a possibility that other factors, such as inflammation that produces a leaky blood-brain barrier, could contribute to the current results (Taheri et al 2011). Indeed, one might expect that people with a history of high blood pressure would have significantly worse low frequency hearing than those without if there was a direct link between vascular disease and hearing.…”

Neurological Diseases in Relation to the Blood–Brain Barrier

“…Disruption of the BBB suggests that vasogenic edema with secondary hypoxia in the white matter may be a contributing factor in the growth of the subcortical lesions (Taheri et al, 2011). Serial MRI scans in patients with Binswanger's disease shows growth of the lesion size rather than discreet stroke-like events ( Figure 5) (unpublished data).…”

Peroxisome Proliferator-Activated Receptor-γ Activation With Angiotensin II Type 1 Receptor Blockade Is Pivotal for the Prevention of Blood-Brain Barrier Impairment and Cognitive Decline in Type 2 Diabetic Mice

“…1 Impairment of the BBB has been suggested to play a key role in the development and progression of several CNS disorders contributing to cognitive decline. 2 Such BBB impairment is mainly caused by hypoxia/ischemia and inflammation. [3][4][5] Type 2 diabetes mellitus (T2DM) has been highlighted as a major risk factor for cognitive decline.…”