Dementia due to vascular disease--a multifactorial disorder.

Scheinberg, Peritz

doi:10.1161/01.str.19.10.1291

Cited by 121 publications

(69 citation statements)

References 60 publications

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“…Although a few studies have shown decreased CBF with normal aging and in patients with chronic, severe hypertension, 32 -34 positron emission tomography studies have not demonstrated a significant increase in oxygen extraction fraction in either the gray or white matter in elderly persons, 35 suggesting that the diminished perfusion is a response to decreased brain metabolism. 36 Perhaps the most convincing CBF study supporting the low periventricular perfusion theory was provided recently by Fazekas et al 10 Using intravenous xenon 133 and an external scintillation detector system, they studied age-matched groups of asymptomatic patients with and without white matter signal abnormalities on MRI and showed slightly lower gray matter blood flow and significantly lower white matter blood flow in the group with MRI lesions.…”

Section: -7mentioning

confidence: 94%

Periventricular lesions on MRI. Facts and theories.

Chimowitz

Awad

Furlan

1989

Stroke

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P atchy subcortical lesions are frequently identified on magnetic resonance imaging (MRI) of the brain in the elderly. 1 -4 On computed tomography (CT) these lesions appear as periventricular zones of lucency and have been termed "leuko-araiosis" by Hachinski and colleagues. 5Despite limited knowledge of the pathological correlates of the lesions, there has been speculation about their nature, pathophysiology, and clinical significance.Epidemiology Subcortical MRI lesions are most commonly seen in the elderly, occurring in 30-92% of patients older than 60 years of age 1 -2 and also in 22% of persons under the age of 40.2 The lesions are found scattered throughout the deep cerebral white matter, notably in the frontal and parieto-occipital periventricular regions, and basal ganglia, especially the globus pallidus and putamen. On T 2 -weighted MRI, the lesions are hyperintense and may appear as thick rims surrounding the lateral ventricles, as caps around the poles of the lateral ventricles, as unifocal patches, or as multifocal subcortical patches that at times are confluent ( Figure I). 6Risk factors associated with these lesions include old age, a history of ischemic cerebrovascular disease, and hypertension.2 -7 -9 With one exception, 10 studies have shown no significant association between these lesions and diabetes, cardiac disease, and carotid disease. However, these studies lack statistical power. There is a high incidence of subcortical MRI lesions in patients with clinically suspected Alzheimer's disease (AD) and senile dementia of the Alzheimer type (SDAT) regardless of their vascular risk factors.

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Section: -7mentioning

confidence: 94%

Periventricular lesions on MRI. Facts and theories.

Chimowitz

Awad

Furlan

1989

Stroke

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“…The observed changes in the subcortical low-flow region with aging could reflect impaired perfusion of the periventricular area due to vascular changes. Al though none of the subjects had severe vascular risk factors or peri ventricular hypodensities on their CT, this finding could precede the peri ventricular leukoencephalopathy seen on CT scans in some pa tients with arterial hypertension and in certain cases of vascular dementia (Scheinberg, 1988). Alterna tively, one could infer that the subcortical white matter tissue as well as neurons are involved in the degenerative process of normal aging.…”

Section: Effect Of Age Sex and Atrophy On Rcbfmentioning

confidence: 95%

^99mTc-d,l-HMPAO and SPECT of the Brain in Normal Aging

Waldemar

Hasselbalch²,

Andersen³

et al. 1991

J Cereb Blood Flow Metab

129

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Summary: Single photon emission computed tomography (SPECT) with 99mTc-d,l-hexamethylpropyleneamine ox ime (99mTc-d,I-HMPAO) was used to determine global and regional CBF in 53 healthy subjects aged 21-83 years. For the whole group, global CBF normalized to the cer ebellum was 86.4% ± 8.4 (SD). The contribution of age, sex, and atrophy to variations in global CBF was studied using stepwise mUltiple regression analysis. There was a significant negative correlation of global CBF with sub jective ratings of cortical atrophy, but not with ratings of ventricular size, Evans ratio, sex, or age. In a subgroup of 33 subjects, in whom volumetric measurements of atro phy were performed, cortical atrophy was the only sig nificant determinant for global CBF, accounting for 27% of its variance. Mean global CBF as measured with the Tomographic measurement of regional CBF (rCBF) in humans was made possible several years ago with the development of a brain-dedicated dy namic single photon emission computed tomogra phy (SPECT) system designed for inhalation or in jection of the diffusible tracer \33Xe (Stokely et ai., 1980). This technique offers easy, repetitive, and quantitative measurements with a spatial and tem poral resolution sufficient for studying cerebrovas cular disease.The recent development of tracers that are re tained in the brain for several hours and, if ideal, "trapped" in proportion to regional blood flow has

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“…14 To address this important issue in a cross-sectional study, we related brain MRI lesions to a variety of cognitive and neurobehavioral function tests in an independent, normal elderly population. Brain MRI scans were analyzed for degree of brain atrophy, location and number of lacunar lesions, and grade of PVHs.…”

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confidence: 99%

Incidental brain lesions on magnetic resonance imaging and neurobehavioral functions in the apparently healthy elderly.

Shimada

Kawamoto

Ozawa

1992

Stroke

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Background and Purpose: Controversies exist whether incidental neuroradiological brain lesions in the elderly are associated with depressed neuropsychological function. To address this important issue in a cross-sectional study, we related brain lesions on magnetic resonance imaging to a variety of cognitive and neurobehavioral function tests in an independent, normal elderly population.Methods: We studied 73 independent asymptomatic elderly individuals (mean±SD age 70 ±6 years) to determine the relations between degree of brain atrophy, location and number of "lacunes," and grade of periventricular hyperintense lesions with a variety of cognitive and neurobehavioral function scores.Results: We found that severity of neuroradiological changes increased while neuropsychological function scores declined with age. After adjustment for the effect of age, advanced periventricular hyperintensities, but not brain atrophy or patchy "lacunar" lesions, were associated with declines in all neuropsychological functions tested.Conclusion: We conclude that incidental advanced periventricular diffuse or patchy white matter changes may play a role in the development of cognitive and neurobehavioral impairments in apparently normal elderly persons. (Stroke 1992;23:175-180)

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Dementia due to vascular disease--a multifactorial disorder.

Cited by 121 publications

References 60 publications

Periventricular lesions on MRI. Facts and theories.

Periventricular lesions on MRI. Facts and theories.

^99mTc-d,l-HMPAO and SPECT of the Brain in Normal Aging

Incidental brain lesions on magnetic resonance imaging and neurobehavioral functions in the apparently healthy elderly.

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