Poststroke Cognitive Decline is Independent of Longitudinal Changes in Cerebral Hemodynamics Parameters

Suministrado, Ma Serrie P; Shuang, E; Xu, Jing; Teoh, Hock Luen; Chan, Bernard; Venketasubramanian, Narayanaswamy; Seet, Raymond C.S.; Chen, Christopher; Wong, Boon Seng; Sharma, Vijay K.; Dong, Yi

doi:10.1111/jon.12395

Cited by 6 publications

(6 citation statements)

References 44 publications

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“…The threshold for differentiating between high and low WMHL was set at 5 cm 3 (median value, 0.7% of WM volume, 0.27% of brain volume). Similar to previous studies [30][31][32][33] Gaussian random field theory with a threshold of p<0.05 37 . Similar to the survival analysis, the threshold for differentiating between high and low WMHL was 5 cm 3 .…”

Section: Discussionsupporting

confidence: 88%

White Matter Hyperintensities and Cognitive Decline in de Novo Parkinson’s Disease Patients

Dadar

Zeighami

Yau

et al. 2017

Preprint

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ObjectiveWhite Matter Hyperintensities (WMHs) are associated with cognitive decline in normative aging and Alzheimer’s disease. However, the pathogenesis of cognitive decline in Parkinson’s disease (PD) is not directly related to vascular causes, and therefore the role of WMHs in PD remains unclear. If WMH has a higher impact on cognitive decline in PD, vascular pathology should be assessed and treated with a higher priority in this population. Here we investigate whether WMH leads to increased cognitive decline in PD, and if these effects relate to cortical thinningMethodsTo investigate the role of WMHs in PD, it is essential to study recently-diagnosed/non-treated patients. De novo PD patients and age-matched controls (NPD=365,NControl=174) with FLAIR/T2-weighted scans at baseline were selected from Parkinson’s Progression Markers Initiative (PPMI). WMHs and cortical thickness were measured to analyse the relationship between baseline WMHs and future cognitive decline (follow-up:4.09±1.14 years) and cortical thinning (follow-up:1.05±0.10 years).ResultsHigh WMH load (WMHL) at baseline in PD was associated with increased cognitive decline, significantly more than i) PDs with low WMHL and ii) controls with high WMHL. Furthermore, PD patients with higher baseline WMHL showed more cortical thinning in right frontal lobe than subjects with low WMHL. Cortical thinning of this region also predicted decline in performance on a cognitive test.InterpretationPresence of WMHs in de novo PD patients predicts greater future cognitive decline and cortical thinning than in normal aging. Recognizing WMHs as a potential predictor of cognitive deficit in PD provides an opportunity for timely interventions.

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Section: Discussionsupporting

confidence: 88%

White Matter Hyperintensities and Cognitive Decline in de Novo Parkinson’s Disease Patients

Dadar

Zeighami

Yau

et al. 2017

Preprint

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“…The threshold for differentiating between high and low WMHL was set at 5 cm 3 (median value, 0.7% of WM volume, 0.27% of brain volume). Similar to previous studies ( Suministrado et al, 2017 ; Baracchini et al, 2012 ; Suzuki et al, 2015 ; Joana et al, 2013 ), a stable 2-point drop in MoCA (a drop that persists over the follow-up visits) was considered as the terminal event in the survival analysis and the time from baseline MoCA measurement to the visit where the 2-points drop was detected was considered as survival time. This was consistent with recommendations from our in-house clinical consultation.…”

Section: Methodsmentioning

confidence: 99%

White matter hyperintensities are linked to future cognitive decline in de novo Parkinson's disease patients

Dadar

Zeighami

Yau

et al. 2018

NeuroImage: Clinical

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White Matter Hyperintensities (WMHs) are associated with cognitive decline in aging and Alzheimer's disease. However, the pathogenesis of cognitive decline in Parkinson's disease (PD) is not as clearly related to vascular causes, and therefore the role of WMHs as a marker of small-vessel disease (SVD) in PD is less clear. Currently, SVD in PD is assessed and treated independently of the disease. However, if WMH as the major MRI sign of SVD has a higher impact on cognitive decline in PD patients than in healthy controls, vascular pathology needs to be assessed and treated with a higher priority in this population. Here we investigate whether the presence of WMHs leads to increased cognitive decline in de novo PD, and if these effects relate to cortical atrophy. WMHs and cortical thickness were measured in de novo PD patients and age-matched controls (NPD = 365, NControl = 174) from Parkinson's Progression Markers Initiative (PPMI) to study the relationship between baseline WMHs, future cognitive decline (follow-up: 4.09 ± 1.14 years) and cortical atrophy (follow-up: 1.05 ± 0.10 years). PD subjects with high baseline WMH loads had significantly greater cognitive decline than i) PD subjects with low WMH load, and ii) control subjects with high WMH load. Furthermore, in PD subjects, high WMH load resulted in more cortical thinning in the right frontal lobe. Theses results show that the presence of WMHs in de novo PD patients predicts greater future cognitive decline and cortical atrophy than in normal aging.

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“…The principal mechanisms involved are chronic hypoperfusion, microembolization and cerebrovascular reactivity impairment. Therefore, assessment of CVR may help identifying high-risk patients who may benefit from revascularization (Shroder et al 2019 ) Acute ischemic stroke The correlation between impairment of CVR and the occurrence of acute ischemic stroke in patients with severe internal carotid artery stenosis has been convincingly confirmed (Gur et al 1996 ; Silvestrini et al 1996 ; Silvestrini et al 2000 ; Markus and Cullinane 2001 ; Cheng et al 2012 ; Viticchi et al 2021 ) Alterations of hemodynamic factors and CVR have been related to the final infarct volume, unfavorable long-term outcome and most neurologic complications after acute stroke (Alvarez et al 2004 ) Cerebral hemodynamic parameters are progressively compromised according to stroke severity (Salinet et al 2019 ) In lacunar infarcts, the increase in PI has been correlated with impairment of executive functions (Sivakumar et al 2017 ) A recent pilot study and suggested that hemodynamic alterations may contribute at worsening cognitive performances transiently, during the first 3–6 months following acute subcortical ischemia (Suministrado et al 2017 ) Cerebral hemodynamic impairment plays a significant pathophysiological role in the acute phase of cerebral ischemia, and somehow predicts stroke severity, progression and long-term outcome …”

Section: Discussionmentioning

confidence: 99%

“…This may lead to vascular contraction and hypoperfusion, in turn causing functional alterations of connectivity within associative networks (Chi et al 2020 ). A recent pilot study, however, did not support such hypothesis, and suggested that hemodynamic alterations may contribute at worsening cognitive performances transiently, during the first 3–6 months following acute subcortical ischemia (Suministrado et al 2017 ).…”

Section: Cvr In Cerebrovascular Diseasesmentioning

confidence: 98%

The impact of cerebral vasomotor reactivity on cerebrovascular diseases and cognitive impairment

et al. 2022

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The regulation of cerebral blood flow (CBF) is a complex and tightly controlled function ensuring delivery of oxygen and nutrients and removal of metabolic wastes from brain tissue. Cerebral vasoreactivity (CVR) refers to the ability of the nervous system to regulate CBF according to metabolic demands or changes in the microenvironment. This can be assessed through a variety of nuclear medicine and imaging techniques and protocols. Several studies have investigated the association of CVR with physiological and pathological conditions, with particular reference to the relationship with cognitive impairment and cerebrovascular disorders (CVD). A better understanding of the interaction between CVR and cognitive dysfunction in chronic and particularly acute CVD could help improving treatment and rehabilitation strategies in these patients. In this paper, we reviewed current knowledge on CVR alterations in the context of acute and chronic CVD and cognitive dysfunction. Alterations in CVR and hemodynamics have been described in patients with both neurodegenerative and vascular cognitive impairment, and the severity of these alterations seems to correlate with CVR derailment. Furthermore, an increased risk of cognitive impairment progression has been associated with alterations in CVR parameters and hemodynamics. Few studies have investigated these associations in acute cerebrovascular disorders and the results are inconsistent; thus, further research on this topic is encouraged.

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Poststroke Cognitive Decline is Independent of Longitudinal Changes in Cerebral Hemodynamics Parameters

Abstract: Although hemodynamic parameters deteriorate in a considerable proportion of patients during first 3-6 months after a cerebrovascular event, cognitive decline appears to be an independent phenomenon.

Cited by 6 publications

References 44 publications

White Matter Hyperintensities and Cognitive Decline in de Novo Parkinson’s Disease Patients

White Matter Hyperintensities and Cognitive Decline in de Novo Parkinson’s Disease Patients

White matter hyperintensities are linked to future cognitive decline in de novo Parkinson's disease patients

The impact of cerebral vasomotor reactivity on cerebrovascular diseases and cognitive impairment

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