Decreased Cerebrospinal Fluid Flow Is Associated With Cognitive Deficit in Elderly Patients

Abstract

Background: Disruptions in cerebrospinal fluid (CSF) flow during aging could compromise protein clearance from the brain and contribute to the etiology of Alzheimer’s Disease (AD). Objective: To determine whether CSF flow is associated with cognitive deficit in elderly patients (>70 years). Methods: We studied 92 patients admitted to our geriatric unit for non-acute reasons using phase-contrast magnetic resonance imaging (PC-MRI) to calculate their ventricular and spinal CSF flow, and assessed their global cognitive status, memory, executive functions, and praxis. Multivariable regressions with backward selection (criterion p < 0.15) were performed to determine associations between cognitive tests and ventricular and spinal CSF flow, adjusting for depression, anxiety, and cardiovascular risk factors. Results: The cohort comprised 71 women (77%) and 21 (33%) men, aged 84.1 ± 5.2 years (range, 73–96). Net ventricular CSF flow was 52 ± 40 μL/cc (range, 0–210), and net spinal CSF flow was 500 ± 295 μL/cc (range, 0–1420). Ventricular CSF flow was associated with the number of BEC96 figures recognized (β = 0.18, CI, 0.02–0.33; p = 0.025). Spinal CSF flow was associated with the WAIS Digit Span Backward test (β = 0.06, CI, 0.01–0.12; p = 0.034), and categoric verbal fluency (β = 0.53, CI, 0.07–0.98; p = 0.024) and semantic verbal fluency (β = 0.55, CI, 0.07–1.02; p = 0.024). Conclusion: Patients with lower CSF flow had significantly worse memory, visuo-constructive capacities, and verbal fluency. Alterations in CSF flow could contribute to some of the cognitive deficit observed in patients with AD. Diagnosis and treatment of CSF flow alterations in geriatric patients with neurocognitive disorders could contribute to the prevention of their cognitive decline.

Assessment of the Willis circle flow changes and the severity of degenerative aortic stenosis and cognitive impairment

“…Concomitant conditions such as age, diabetes and chronic renal failure or left ventricle systolic function occurred independent determinants of cognitive status. This is in line with data from observational studies [35][36][37][38][39].…”

“…Diabetes occurred an important predictor of cognitive decline in the elderly, associated with deficits in attention and executive functions in some studies, whereas the greater the severity of chronic kidney disease, the greater the progression of cognitive decline was observed [35][36][37][38]. At present, the main treatment for vascular cognitive impairment is prevention by treating vascular diseases and other risk factors, such as hypertension and diabetes mellitus [40].…”

Sex and Age Dependencies of Aqueductal Cerebrospinal Fluid Dynamics Parameters in Healthy Subjects

“…In our study, age and sex only explain a small part of the variability of values of CSF flow dynamics parameters in the aqueduct as demonstrated by the adjusted R 2 of the linear regression models. Yet this is not surprising as CSF flow in the aqueduct may be impacted by various factors such as biochemical parameters or cerebrovascular and brain pulsation (Mase et al, 1998; Chiang et al, 2009; Schmid Daners et al, 2012; Puy et al, 2016; Attier-Zmudka et al, 2019). Nonetheless between 6 and 18% of the variability in all parameters may be explained only by the two factors sex and age.…”

“…Interestingly, a very recent study (Attier-Zmudka et al, 2019) has observed decreased CSF flow in elderly patients with cognitive deficits whereby ventricular CSF flow was significantly associated with patient’s performance on an instrumental cognition test.…”

The Contribution of Plasma and Brain Vitamin C on Age and Gender-Related Cognitive Differences: A Mini-Review of the Literature

“…CSF turnover can also be disrupted during aging. One recent study demonstrated significantly reduced CSF flow during aging by calculating ventricular and spinal CSF flow in a cohort of elderly participants (Attier-Zmudka et al, 2019 ) which was associated with cognitive performance. Since CSF is important for transporting ascorbate into the extracellular neuronal space and is the fluid which neurons are exposed to, possibly the impaired CSF flow during aging could be associated with reduced transportation of ascorbic acid into neurons.…”