Cognitive function correlates with frontal white matter apparent diffusion coefficients in patients with leukoaraiosis

Viana-Baptista, Miguel; Bugalho, Paulo; Jordão, Constança; Ferreira, Naide; Ferreira, Álvaro; Secca, Mário Forjaz; Esperança-Pina, J. A.; Ferro, José M.

doi:10.1007/s00415-008-0661-9

Cited by 28 publications

(35 citation statements)

References 29 publications

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“…There existed a significant association between white matter lesion load and severity of DTI and MTR measures in the normalappearing white matter with the microstructural changes in normal brain tissue being more closely related to the patients' clinical presentation than the volume of visible white matter abnormalities [9,32,52,61,69,70,74,92,93]. These observations clearly indicate that age-related small vessel disease of the brain is a diffuse process affecting the entire brain and that white matter lesions are probably only the tip of the iceberg.…”

Section: Age-related White Matter Changes and Normal-appearing Brain mentioning

confidence: 83%

Heterogeneity in age-related white matter changes

et al. 2011

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White matter changes occur endemically in routine magnetic resonance imaging (MRI) scans of elderly persons. MRI appearance and histopathological correlates of white matter changes are heterogeneous. Smooth periventricular hyperintensities, including caps around the ventricular horns, periventricular lining and halos are likely to be of non-vascular origin. They relate to a disruption of the ependymal lining with subependymal widening of the extracellular space and have to be differentiated from subcortical and deep white matter abnormalities. For the latter a distinction needs to be made between punctate, early confluent and confluent types. Although punctate white matter lesions often represent widened perivascular spaces without substantial ischemic tissue damage, early confluent and confluent lesions correspond to incomplete ischemic destruction. Punctate abnormalities on MRI show a low tendency for progression, while early confluent and confluent changes progress rapidly. The causative and modifying pathways involved in the occurrence of sporadic age-related white matter changes are still incompletely understood, but recent microarray and genome-wide association approaches increased the notion of pathways that might be considered as targets for therapeutic intervention. The majority of differentially regulated transcripts in white matter lesions encode genes associated with immune function, cell cycle, proteolysis, and ion transport. Genome-wide association studies identified six SNPs mapping to a locus on chromosome 17q25 to be related to white matter lesion load in the general population. We also report first and preliminary data that demonstrate apolipoprotein E (ApoE) immunoreactivity in white matter lesions and support epidemiological findings indicating that ApoE is another factor possibly related to white matter lesion occurrence. Further insights come from modern MRI techniques, such as diffusion tensor and magnetization transfer imaging, as they provide tools for the characterization of

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Section: Age-related White Matter Changes and Normal-appearing Brain mentioning

confidence: 83%

Heterogeneity in age-related white matter changes

et al. 2011

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“…CVRF, age, and WML were found to be significantly related, particularly in studies performed on leukoaraiosis patients 19 .…”

Section: Patientsmentioning

confidence: 87%

Normal pressure hydrocephalus: a qualitative study on outcome

Bugalho

Alves

Ribeiro

2013

Arq. Neuro-Psiquiatr.

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Objective: To describe the natural history and shunt outcome in patients with normal pressure hydrocephalus (NPH) and the variables that influence both. Method: Motor and cognitive parameters of 35 patients with NPH, as well as shunt surgery status, were registered at two time points (T0 and T1). Results: Thirteen patients underwent shunt surgery. Favorable outcome in gait function occurred in 5 of 35 patients and was related to younger age, absence of cardiovascular risk factors (CVRF) and white matter lesions (WML), and shunt surgery. Cognitive outcome was favorable in 9 of 35 patients and associated with shunt surgery (trend level). Of the patients subjected to surgery, favorable outcome in motor function was related to younger age at T0 and absence of CVRF and WML (trend level). Conclusion: Shunt surgery had a significant effect on gait and less on cognition. Favorable outcome in gait was also associated with younger age and absence of CVRF and WML.Keywords: normal pressure hydrocephalus, natural history, shunt surgery. REsumo:Objetivo: Descrever a história natural e o prognóstico após cirurgia de derivação ventricular em doentes com hidrocefalia de pressão normal (HPN), e as variáveis que potencialmente os influenciam. Método: Foram registados os parâmetros motores e cognitivos de 35 doentes com HPN, assim como o status relativo a cirurgia, em dois pontos no tempo (T0 e T1). Resultados: Treze doentes foram submetidos a cirurgia. Melhoria na marcha ocorreu em 5 doentes e relacionou-se com idade mais jovem, ausência de factores de risco cardio-vascular (FRCV), ausência de lesões da substância branca (LSB) e colocação de derivação ventricular. Verificou-se melhoria cognitiva em 9 doentes, associada (p=0,05) com colocação de derivação ventricular. Em doentes submetidos a cirurgia, o prognóstico favorável a nível motor relacionou-se com idade mais jovem em T0, ausência de FRCV e de LSB. Conclusão: A cirurgia para colocação de derivação ventricular teve um efeito significativo sobre a marcha e menor na cognição. O prognóstico favorável na marcha parece também associar-se a idade mais jovem, a ausência de FRV e de LSB.Palavras-chave: hidrocefalia de pressão normal, história natural, cirurgia de derivação ventriculo-peritoneal.Normal pressure hydrocephalus (NPH) was first des cri bed by Hakim and Adams as a syndrome that consisted of the triad of gait dysfunction, dementia, and urinary in continence, was associated with ventricular dilation, was potentially treatable by cerebrospinal fluid (CSF) surgical derivation (shunt surgery) 1

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“…Further studies are needed to clarify if these deficits might precede significant cognitive decline. On the other hand, diffusion weighted imaging measures demonstrate brain tissue alterations in normal appearing white matter, even in patients with few WML [47,51], showing a more promising ability to quantify clinically relevant alterations, similar to what has been found in age-related WML [52,53]. Further evidence of small vessel involvement may be present, including lacunar infarcts (Fig.…”

Section: Prognosis and Treatment Of Stroke In Fabry Diseasementioning

confidence: 56%

Stroke and Fabry disease

Viana-Baptista

2011

J Neurol

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Fabry disease (FD) is a rare inherited disorder of the metabolism, associated with renal, cardiac, and cerebrovascular complications. Ischemic and hemorrhagic stroke in FD present with a similar proportion to that observed in the general population, but usually at an early age. Ischemic stroke may result from cardiac embolism, large and small vessel disease, while hemorrhagic stroke is usually attributed to hypertension. Deposition of glycosphingolipids in endothelial cells results in a specific FD vasculopathy that contributes to the different vascular phenotypes. Neuroimaging features of cerebrovascular involvement in FD include white matter lesions, dolichoectasia, and the "pulvinar sign", a T1 MRI hyperintensity of the posterior thalamus. The role of enzymatic replacement therapy in the prevention of stroke remains to be established, but its utilization should be considered in FD stroke patients, for prevention of renal and cardiac complications, together with general prevention measures. Enzymatic replacement therapy increased our awareness of FD, underlining the importance of incomplete phenotypes in specific settings such as stroke. An overview of studies on the prevalence of FD in stroke patients is presented. Available data suggest that prevalence of FD is similar to some of the rare causes of stroke usually considered, and that classic features of the disease may be absent or more subtle. Moreover, FD should be considered in both cryptogenic and all-cause stroke. The role of FD in stroke on a multifactorial basis and the identification of a putative "stroke variant" are questions that need to be further elucidated in future studies.

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Cognitive function correlates with frontal white matter apparent diffusion coefficients in patients with leukoaraiosis

Cited by 28 publications

References 29 publications

Heterogeneity in age-related white matter changes

Heterogeneity in age-related white matter changes

Normal pressure hydrocephalus: a qualitative study on outcome

Stroke and Fabry disease

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