Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know

Mahammedi, Abdelkader; Wang, L.L.; Williamson, Brady J.; Khatri, Pooja; Kissela, Brett M; Sawyer, Russell P.; Shatz, Rhonna; Khandwala, Vivek; Vagal, Achala

doi:10.3174/ajnr.a7302

Cited by 16 publications

(15 citation statements)

References 80 publications

(152 reference statements)

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“…Lacunes were counted in accordance with the standards for reporting vascular changes on neuroimaging. 27 Lacunes were defined as round or ovoid, subcortical, fluid-filled cavities (signal similar to cerebrospinal fluid) between 3 mm to about 15 mm in diameter, consistent with a previous acute small subcortical infarct or hemorrhage in the territory of one perforating arteriole according to STRIVE guidelines. 28 Considering that our FLAIR images were obtained at a thickness of 2 mm and no gap, we counted the number of lacunes on every other FLAIR image.…”

Section: Methodsmentioning

confidence: 99%

White Matter Lesions Predominantly Located in Deep White Matter Represent Embolic Etiology Rather Than Small Vessel Disease

Jung

Park

Lee

et al. 2023

Dement Neurocogn Disord

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Background and Purpose We investigated the correlation between the deep distribution of white matter hyperintensity (WMH) (dWMH: WMH in deep and corticomedullary areas, with minimal periventricular WMH) and a positive agitated saline contrast echocardiography result. Methods We retrospectively recruited participants with comprehensive dementia evaluations, an agitated saline study, and brain imaging. The participants were classified into two groups according to WMH-distributions: dWMH and dpWMH (mainly periventricular WMH with or without deep WMH.) We hypothesized that dWMH is more likely associated with embolism, whereas dpWMH is associated with small-vessel diseases. We compared the clinical characteristics, WMH-distributions, and positive rate of agitated saline studies between the two groups. Results Among 90 participants, 27 and 12 met the dWMH and dpWMH criteria, respectively. The dWMH-group was younger (62.2±7.5 vs. 78.9±7.3, p <0.001) and had a lower prevalence of hypertension (29.6% vs. 75%, p =0.008), diabetes mellitus (3.7% vs. 25%, p =0.043), and hyperlipidemia (33.3% vs. 83.3%, p =0.043) than the dpWMH-group. Regarding deep white matter lesions, the number of small lesions (<3 mm) was higher in the dWMH-group(10.9±9.7) than in the dpWMH-group (3.1±6.4) ( p =0.008), and WMH was predominantly distributed in the border-zones and corticomedullary areas. Most importantly, the positive agitated saline study rate was higher in the dWMH-group than in the dpWMH-group (81.5% vs. 33.3%, p =0.003). Conclusions The dWMH-group with younger participants had fewer cardiovascular risk factors, showed more border-zone-distributions, and had a higher agitated saline test positivity rate than the dpWMH-group, indicating that corticomedullary or deep WMH-distribution with minimal periventricular WMH suggests embolic etiologies.

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Section: Methodsmentioning

confidence: 99%

White Matter Lesions Predominantly Located in Deep White Matter Represent Embolic Etiology Rather Than Small Vessel Disease

Jung

Park

Lee

et al. 2023

Dement Neurocogn Disord

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“…CAA and HA are distinct microangiopathies with differentiated pathophysiologies, clinical significances, and prognoses [17]. There are well established associations of CAA and HA with distributions of magnetic resonance imaging (MRI) markers, including cerebral microbleeds (CMBs), white matter hyperintensities (WMH), lacunar infarcts, and perivascular space enlargements (PVSEs) that are helpful for differentiating between CAA and HA neuroradiologically [18]. CAA is characteristic of progressive β-amyloid deposition in small cortical vessels overlying the leptomeninges and gray-WM junction, while HA primarily affects the small perforating arteries of deep gray nuclei and deep WM [19].…”

Section: Introductionmentioning

confidence: 99%

Imaging markers of cerebral amyloid angiopathy and hypertensive arteriopathy differentiate Alzheimer disease subtypes synergistically

et al. 2022

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Background Both cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy (HA) are related to cognitive impairment and dementia. This study aimed to clarify CAA- and HA-related small vessel disease (SVD) imaging marker associations with cognitive dysfunction and Alzheimer disease (AD) subtypes. Methods A sample of 137 subjects with clinically diagnosed late-onset AD identified from the dementia registry of a single center from January 2017 to October 2021 were enrolled. Semi-quantitative imaging changes (visual rating scale grading) suggestive of SVD were analyzed singularly and compositely, and their correlations with cognitive domains and AD subtypes were examined. Results Patients with typical and limbic-predominant AD subtypes had worse cognitive performance and higher dementia severity than minimal-atrophy subtype patients. Deep white matter hyperintensity (WMH) presence correlated inversely with short-term memory (STM) performance. The three composite SVD scores correlated with different cognitive domains and had distinct associations with AD subtypes. After adjusting for relevant demographic factors, multivariate logistic regression (using minimal-atrophy subtype as the reference condition) revealed the following: associations of the typical subtype with periventricular WMH [odds ratio (OR) 2.62; 95% confidence interval (CI), 1.23–5.57, p = 0.012], global SVD score (OR 1.67; 95%CI, 1.11–2.52, p = 0.009), and HA-SVD score (OR 1.93; 95%CI, 1.10–3.52, p = 0.034); associations of limbic-predominant subtype with HA-SVD score (OR 2.57; 95%CI, 1.23–5.37, p = 0.012) and most global and domain-specific cognitive scores; and an association of hippocampal-sparing subtype with HA-SVD score (OR 3.30; 95%CI, 1.58–6.85, p = 0.001). Conclusion Composite SVD imaging markers reflect overall CAA and/or HA severity and may have differential associations with cognitive domains and AD subtypes. Our finding supports the possibility that the clinical AD subtypes may reflect differing burdens of underlying CAA and HA microangiopathologies.

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“…In addition, diabetes is associated with increased rates of atrophy (Moran et al, 2013 ). Again, it is not known whether there are sex-related differences in this association, but it is known that atrophy and cSVD are closely related, and they are sometimes even collectively referred to as “brain structure” or “markers for brain health” (Mahammedi et al, 2021 ). Our primary goal in the present analysis is to assess if there are sex-specific pattern in the relationship between diabetes and brain structure, including cSVD and atrophy, and cognitive function as their clinical correlates.…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Associations of Diabetes With Brain Structure and Function in a Geriatric Population

Thomas

Rhodius-Meester

Exalto

et al. 2022

Front. Aging Neurosci.

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IntroductionGlobally, women with dementia have a higher disease burden than men with dementia. In addition, women with diabetes especially are at higher risk for cognitive impairment and dementia compared to men with diabetes. Differences in the influence of diabetes on the cerebral vasculature and brain structure may contribute to these sex-specific differences. We examined sex-specific patterns in the relationship between diabetes and brain structure, as well as diabetes and cognitive function.MethodsIn total, 893 patients [age 79 ± 6.6 years, 446 (50%) women] from the Amsterdam Ageing Cohort with available data on brain structures (assessed by an MRI or CT scan) and cognitive function were included. All patients underwent a thorough standardized clinical and neuropsychological assessment (including tests on memory, executive functioning, processing speed, language). Brain structure abnormalities were quantified using visual scales.ResultsCross-sectional multivariable regression analyses showed that diabetes was associated with increased incidence of cerebral lacunes and brain atrophy in women (OR 2.18 (1.00–4.72) but not in men. Furthermore, diabetes was associated with decreased executive function, processing speed and language in women [B −0.07 (0.00–0.13), −0.06 (0.02–0.10) and −0.07 (0.01–0.12) resp.] but not in men.ConclusionsDiabetes is related to increased risk of having lacunes, brain atrophy and impaired cognitive function in women but not in men. Further research is required to understand the time trajectory leading up to these changes and to understand the mechanisms behind them in order to improve preventive health care for both sexes.

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Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know

Cited by 16 publications

References 80 publications

White Matter Lesions Predominantly Located in Deep White Matter Represent Embolic Etiology Rather Than Small Vessel Disease

White Matter Lesions Predominantly Located in Deep White Matter Represent Embolic Etiology Rather Than Small Vessel Disease

Imaging markers of cerebral amyloid angiopathy and hypertensive arteriopathy differentiate Alzheimer disease subtypes synergistically

Sex-Specific Associations of Diabetes With Brain Structure and Function in a Geriatric Population

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