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[PMID]:28468952
[Au] Autor:González-Castro V; Valdés Hernández MDC; Chappell FM; Armitage PA; Makin S; Wardlaw JM
[Ad] Endereço:Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, U.K. victor.gonzalez@ed.ac.uk M.Valdes-Hernan@ed.ac.uk.
[Ti] Título:Reliability of an automatic classifier for brain enlarged perivascular spaces burden and comparison with human performance.
[So] Source:Clin Sci (Lond);131(13):1465-1481, 2017 Jul 01.
[Is] ISSN:1470-8736
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:In the brain, enlarged perivascular spaces (PVS) relate to cerebral small vessel disease (SVD), poor cognition, inflammation and hypertension. We propose a fully automatic scheme that uses a support vector machine (SVM) to classify the burden of PVS in the basal ganglia (BG) region as low or high. We assess the performance of three different types of descriptors extracted from the BG region in T2-weighted MRI images: (i) statistics obtained from Wavelet transform's coefficients, (ii) local binary patterns and (iii) bag of visual words (BoW) based descriptors characterizing local keypoints obtained from a dense grid with the scale-invariant feature transform (SIFT) characteristics. When the latter were used, the SVM classifier achieved the best accuracy (81.16%). The output from the classifier using the BoW descriptors was compared with visual ratings done by an experienced neuroradiologist (Observer 1) and by a trained image analyst (Observer 2). The agreement and cross-correlation between the classifier and Observer 2 (κ = 0.67 (0.58-0.76)) were slightly higher than between the classifier and Observer 1 (κ = 0.62 (0.53-0.72)) and comparable between both the observers (κ = 0.68 (0.61-0.75)). Finally, three logistic regression models using clinical variables as independent variable and each of the PVS ratings as dependent variable were built to assess how clinically meaningful were the predictions of the classifier. The goodness-of-fit of the model for the classifier was good (area under the curve (AUC) values: 0.93 (model 1), 0.90 (model 2) and 0.92 (model 3)) and slightly better (i.e. AUC values: 0.02 units higher) than that of the model for Observer 2. These results suggest that, although it can be improved, an automatic classifier to assess PVS burden from brain MRI can provide clinically meaningful results close to those from a trained observer.
[Mh] Termos MeSH primário: Gânglios da Base/patologia
Doenças de Pequenos Vasos Cerebrais/patologia
Máquina de Vetores de Suporte
[Mh] Termos MeSH secundário: Idoso
Atrofia
Gânglios da Base/diagnóstico por imagem
Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem
Seres Humanos
Processamento de Imagem Assistida por Computador/métodos
Imagem por Ressonância Magnética/métodos
Meia-Idade
Variações Dependentes do Observador
Curva ROC
Reprodutibilidade dos Testes
Sensibilidade e Especificidade
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/patologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1042/CS20170051


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[PMID]:28991905
[Au] Autor:Nam KW; Kwon HM; Lim JS; Han MK; Nam H; Lee YS
[Ad] Endereço:Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
[Ti] Título:The presence and severity of cerebral small vessel disease increases the frequency of stroke in a cohort of patients with large artery occlusive disease.
[So] Source:PLoS One;12(10):e0184944, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cerebral small vessel disease (SVD) commonly coexists with large artery atherosclerosis (LAA). AIM: We evaluate the effect of SVD on stroke recurrence in patients for ischemic stroke with LAA. METHODS: We consecutively collected first-ever ischemic stroke patients who were classified as LAA mechanism between Jan 2010 and Dec 2013. Univariate and multivariate Cox analyses were performed to evaluate the association between the 2-year recurrence and demographic, clinical, and radiological factors. To evaluate the impact of SVD and its components on recurrent stroke, we used the Kaplan-Meier analysis. SVD was defined as the presence of severe white matter hyperintensity (WMH) or old lacunar infarction (OLI) or cerebral microbleeds (CMB). We also compared frequency and burden of SVD among recurrent stroke groups with different mechanisms. RESULTS: Among a total of 956 participants, 92 patients had recurrent events. Recurrence group showed a higher frequency of severe WMH, OLI, asymptomatic territorial infarction, and severe stenosis on the relevant vessel in multivariate analysis. The impact of SVD and its components on recurrent stroke was significant in any ischemic recurrent stroke, and the presence of SVD was continuously important in stroke recurrence regardless of its mechanism, including recurrent LAA stroke, recurrent small vessel occlusion stroke, and even recurrent cardioembolic stroke. Additionally, the recurrence rate increased in dose-response manner with the increased number of SVD components. CONCLUSIONS: Cerebral SVD is associated with recurrent stroke in patients with LAA. Additionally, it may affect any mechanisms of recurrent stroke and even with a dose response manner.
[Mh] Termos MeSH primário: Aterosclerose/complicações
Doenças de Pequenos Vasos Cerebrais/complicações
Acidente Vascular Cerebral/etiologia
[Mh] Termos MeSH secundário: Idoso
Aterosclerose/patologia
Doenças de Pequenos Vasos Cerebrais/patologia
Estudos de Coortes
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Análise Multivariada
Recidiva
Acidente Vascular Cerebral/patologia
Acidente Vascular Cerebral Lacunar/etiologia
Acidente Vascular Cerebral Lacunar/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184944


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[PMID]:28978655
[Au] Autor:Zeestraten EA; Lawrence AJ; Lambert C; Benjamin P; Brookes RL; Mackinnon AD; Morris RG; Barrick TR; Markus HS
[Ad] Endereço:From the Neuroscience Research Centre (E.A.Z., C.L., P.B., T.R.B.), Cardiovascular and Cell Sciences Research Institute, St George's University of London; Stroke Research Group (A.J.L., R.L.B., H.S.M.), Clinical Neurosciences, University of Cambridge; Atkinson Morley Regional Neuroscience Centre (A.
[Ti] Título:Change in multimodal MRI markers predicts dementia risk in cerebral small vessel disease.
[So] Source:Neurology;89(18):1869-1876, 2017 Oct 31.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether MRI markers, including diffusion tensor imaging (DTI), can predict cognitive decline and dementia in patients with cerebral small vessel disease (SVD). METHODS: In the prospective St George's Cognition and Neuroimaging in Stroke study, multimodal MRI was performed annually for 3 years and cognitive assessments annually for 5 years in a cohort of 99 patients with SVD, defined as symptomatic lacunar stroke and confluent white matter hyperintensities (WMH). Progression to dementia was determined in all patients. Progression of WMH, brain volume, lacunes, cerebral microbleeds, and a DTI measure (the normalized peak height of the mean diffusivity histogram distribution) as a marker of white matter microstructural damage were determined. RESULTS: Over 5 years of follow-up, 18 patients (18.2%) progressed to dementia. A significant change in all MRI markers, representing deterioration, was observed. The presence of new lacunes, and rate of increase in white matter microstructural damage on DTI, correlated with both decline in executive function and global functioning. Growth of WMH and deterioration of white matter microstructure on DTI predicted progression to dementia. A model including change in MRI variables together with their baseline values correctly classified progression to dementia with a C statistic of 0.85. CONCLUSIONS: This longitudinal prospective study provides evidence that change in MRI measures including DTI, over time durations during which cognitive change is not detectable, predicts cognitive decline and progression to dementia. It supports the use of MRI measures, including DTI, as useful surrogate biomarkers to monitor disease and assess therapeutic interventions.
[Mh] Termos MeSH primário: Doenças de Pequenos Vasos Cerebrais/complicações
Demência/diagnóstico por imagem
Demência/etiologia
Imagem Multimodal/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Transtornos Cognitivos/diagnóstico por imagem
Transtornos Cognitivos/etiologia
Estudos de Coortes
Feminino
Seres Humanos
Interpretação de Imagem Assistida por Computador
Masculino
Entrevista Psiquiátrica Padronizada
Meia-Idade
Testes Neuropsicológicos
Valor Preditivo dos Testes
Escalas de Graduação Psiquiátrica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171006
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004594


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[PMID]:28878046
[Au] Autor:van Leijsen EMC; van Uden IWM; Ghafoorian M; Bergkamp MI; Lohner V; Kooijmans ECM; van der Holst HM; Tuladhar AM; Norris DG; van Dijk EJ; Rutten-Jacobs LCA; Platel B; Klijn CJM; de Leeuw FE
[Ad] Endereço:From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medi
[Ti] Título:Nonlinear temporal dynamics of cerebral small vessel disease: The RUN DMC study.
[So] Source:Neurology;89(15):1569-1577, 2017 Oct 10.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate the temporal dynamics of cerebral small vessel disease (SVD) by 3 consecutive assessments over a period of 9 years, distinguishing progression from regression. METHODS: Changes in SVD markers of 276 participants of the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) cohort were assessed at 3 time points over 9 years. We assessed white matter hyperintensities (WMH) volume by semiautomatic segmentation and rated lacunes and microbleeds manually. We categorized baseline WMH severity as mild, moderate, or severe according to the modified Fazekas scale. We performed mixed-effects regression analysis including a quadratic term for increasing age. RESULTS: Mean WMH progression over 9 years was 4.7 mL (0.54 mL/y; interquartile range 0.95-5.5 mL), 20.3% of patients had incident lacunes (2.3%/y), and 18.9% had incident microbleeds (2.2%/y). WMH volume declined in 9.4% of the participants during the first follow-up interval, but only for 1 participant (0.4%) throughout the whole follow-up. Lacunes disappeared in 3.6% and microbleeds in 5.7% of the participants. WMH progression accelerated over time: including a quadratic term for increasing age during follow-up significantly improved the model ( < 0.001). SVD progression was predominantly seen in participants with moderate to severe WMH at baseline compared to those with mild WMH (odds ratio [OR] 35.5, 95% confidence interval [CI] 15.8-80.0, < 0.001 for WMH progression; OR 5.7, 95% CI 2.8-11.2, < 0.001 for incident lacunes; and OR 2.9, 95% CI 1.4-5.9, = 0.003 for incident microbleeds). CONCLUSIONS: SVD progression is nonlinear, accelerating over time, and a highly dynamic process, with progression interrupted by reduction in some, in a population that on average shows progression.
[Mh] Termos MeSH primário: Doenças de Pequenos Vasos Cerebrais
Leucoencefalopatias
Dinâmica não Linear
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Doenças de Pequenos Vasos Cerebrais/complicações
Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem
Doenças de Pequenos Vasos Cerebrais/epidemiologia
Estudos de Coortes
Progressão da Doença
Feminino
Seres Humanos
Processamento de Imagem Assistida por Computador
Leucoencefalopatias/diagnóstico por imagem
Leucoencefalopatias/epidemiologia
Leucoencefalopatias/etiologia
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170908
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004490


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[PMID]:28798076
[Au] Autor:Mestre H; Kostrikov S; Mehta RI; Nedergaard M
[Ad] Endereço:Department of Neurosurgery, Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY 14642, U.S.A.
[Ti] Título:Perivascular spaces, glymphatic dysfunction, and small vessel disease.
[So] Source:Clin Sci (Lond);131(17):2257-2274, 2017 Sep 01.
[Is] ISSN:1470-8736
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Cerebral small vessel diseases (SVDs) range broadly in etiology but share remarkably overlapping pathology. Features of SVD including enlarged perivascular spaces (EPVS) and formation of abluminal protein deposits cannot be completely explained by the putative pathophysiology. The recently discovered glymphatic system provides a new perspective to potentially address these gaps. This work provides a comprehensive review of the known factors that regulate glymphatic function and the disease mechanisms underlying glymphatic impairment emphasizing the role that aquaporin-4 (AQP4)-lined perivascular spaces (PVSs), cerebrovascular pulsatility, and metabolite clearance play in normal CNS physiology. This review also discusses the implications that glymphatic impairment may have on SVD inception and progression with the aim of exploring novel therapeutic targets and highlighting the key questions that remain to be answered.
[Mh] Termos MeSH primário: Vasos Sanguíneos/fisiopatologia
Encéfalo/fisiopatologia
Doenças de Pequenos Vasos Cerebrais/fisiopatologia
[Mh] Termos MeSH secundário: Animais
Aquaporina 4/genética
Aquaporina 4/metabolismo
Vasos Sanguíneos/metabolismo
Encéfalo/metabolismo
Doenças de Pequenos Vasos Cerebrais/metabolismo
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Aquaporin 4)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170812
[St] Status:MEDLINE
[do] DOI:10.1042/CS20160381


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[PMID]:28796818
[Au] Autor:Kraft P; Schuhmann MK; Garz C; Jandke S; Urlaub D; Mencl S; Zernecke A; Heinze HJ; Carare RO; Kleinschnitz C; Schreiber S
[Ad] Endereço:Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
[Ti] Título:Hypercholesterolemia induced cerebral small vessel disease.
[So] Source:PLoS One;12(8):e0182822, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: While hypercholesterolemia plays a causative role for the development of ischemic stroke in large vessels, its significance for cerebral small vessel disease (CSVD) remains unclear. We thus aimed to understand the detailed relationship between hypercholesterolemia and CSVD using the well described Ldlr-/- mouse model. METHODS: We used Ldlr-/- mice (n = 16) and wild-type (WT) mice (n = 15) at the age of 6 and 12 months. Ldlr-/- mice develop high plasma cholesterol levels following a high fat diet. We analyzed cerebral capillaries and arterioles for intravascular erythrocyte accumulations, thrombotic vessel occlusions, blood-brain barrier (BBB) dysfunction and microbleeds. RESULTS: We found a significant increase in the number of erythrocyte stases in 6 months old Ldlr-/- mice compared to all other groups (P < 0.05). Ldlr-/- animals aged 12 months showed the highest number of thrombotic occlusions while in WT animals hardly any occlusions could be observed (P < 0.001). Compared to WT mice, Ldlr-/- mice did not display significant gray matter BBB breakdown. Microhemorrhages were observed in one Ldlr-/- mouse that was 6 months old. Results did not differ when considering subcortical and cortical regions. CONCLUSIONS: In Ldlr-/- mice, hypercholesterolemia is related to a thrombotic CSVD phenotype, which is different from hypertension-related CSVD that associates with a hemorrhagic CSVD phenotype. Our data demonstrate a relationship between hypercholesterolemia and the development of CSVD. Ldlr-/- mice appear to be an adequate animal model for research into CSVD.
[Mh] Termos MeSH primário: Doenças de Pequenos Vasos Cerebrais/etiologia
Colesterol/sangue
Hipercolesterolemia/complicações
Receptores de LDL/genética
[Mh] Termos MeSH secundário: Animais
Barreira Hematoencefálica/fisiopatologia
Encéfalo/fisiopatologia
Doenças de Pequenos Vasos Cerebrais/sangue
Doenças de Pequenos Vasos Cerebrais/genética
Doenças de Pequenos Vasos Cerebrais/fisiopatologia
Dieta Hiperlipídica
Modelos Animais de Doenças
Hipercolesterolemia/sangue
Hipercolesterolemia/genética
Hipercolesterolemia/fisiopatologia
Masculino
Camundongos
Camundongos Knockout
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Receptors, LDL); 97C5T2UQ7J (Cholesterol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171009
[Lr] Data última revisão:
171009
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0182822


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[PMID]:28754833
[Au] Autor:Thijs V; Grittner U; Fazekas F; McCabe DJH; Giese AK; Kessler C; Martus P; Norrving B; Ringelstein EB; Schmidt R; Tanislav C; Putaala J; Tatlisumak T; von Sarnowski B; Rolfs A; Enzinger C; Stroke in Fabry (SIFAP1) Investigators
[Ad] Endereço:From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epide
[Ti] Título:Dolichoectasia and Small Vessel Disease in Young Patients With Transient Ischemic Attack and Stroke.
[So] Source:Stroke;48(9):2361-2367, 2017 Sep.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: We evaluated whether basilar dolichoectasia is associated with markers of cerebral small vessel disease in younger transient ischemic attack and ischemic stroke patients. METHODS: We used data from the SIFAP1 study (Stroke in Young Fabry Patients), a large prospective, hospital-based, screening study for Fabry disease in young (<55 years) transient ischemic attack/stroke patients in whom detailed clinical data and brain MRI were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed. RESULTS: Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with older age (odds ratio per decade, 1.26; 95% confidence interval, 1.09-1.44), male sex (odds ratio, 1.96; 95% confidence interval, 1.59-2.42), and hypertension (odds ratio, 1.39; 95% confidence interval, 1.13-1.70). Dolichoectasia was more common in patients with small infarctions (33.9% versus 29.8% for acute lesions, =0.065; 29.1% versus 16.5% for old lesions, <0.001), infarct location in the brain stem (12.4% versus 6.9%, <0.001), and in white matter (27.8% versus 21.1%, =0.001). Microbleeds (16.3% versus 4.7%, =0.001), higher grades of white matter hyperintensities ( <0.001), and small vessel disease subtype (18.1% versus 12.4%, overall for differences in TOAST ( =0.018) were more often present in patients with dolichoectasia. CONCLUSIONS: Dolichoectasia is associated with imaging markers of small vessel disease and brain stem localization of acute and old infarcts in younger patients with transient ischemic attack and ischemic stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583.
[Mh] Termos MeSH primário: Doenças de Pequenos Vasos Cerebrais/epidemiologia
Ataque Isquêmico Transitório/epidemiologia
Acidente Vascular Cerebral/epidemiologia
Insuficiência Vertebrobasilar/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Infartos do Tronco Encefálico/epidemiologia
Hemorragia Cerebral/epidemiologia
Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem
Feminino
Seres Humanos
Hipertensão/epidemiologia
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Razão de Chances
Fatores de Risco
Fatores Sexuais
Insuficiência Vertebrobasilar/diagnóstico por imagem
Substância Branca/irrigação sanguínea
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170730
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.017406


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[PMID]:28715552
[Au] Autor:Ding J; Sigurðsson S; Jónsson PV; Eiriksdottir G; Charidimou A; Lopez OL; van Buchem MA; Guðnason V; Launer LJ
[Ad] Endereço:Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, Maryland.
[Ti] Título:Large Perivascular Spaces Visible on Magnetic Resonance Imaging, Cerebral Small Vessel Disease Progression, and Risk of Dementia: The Age, Gene/Environment Susceptibility-Reykjavik Study.
[So] Source:JAMA Neurol;74(9):1105-1112, 2017 Sep 01.
[Is] ISSN:2168-6157
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: With advancing age, an increased visibility of perivascular spaces (PVSs) on magnetic resonance imaging (MRI) is hypothesized to represent impaired drainage of interstitial fluid from the brain and may reflect underlying cerebral small vessel disease (SVD). However, whether large perivascular spaces (L-PVSs) (>3 mm in diameter) visible on MRI are associated with SVD and cognitive deterioration in older individuals is unknown. Objective: To examine whether L-PVSs are associated with the progression of the established MRI markers of SVD, cognitive decline, and increased risk of dementia. Design, Setting, and Participants: The prospective, population-based Age, Gene/Environment Susceptibility-Reykjavik Study assessed L-PVSs at baseline (September 1, 2002, through February 28, 2006) on MRI studies of the brain in 2612 participants. Participants returned for additional MRI from April 1, 2007, through September 30, 2011, and underwent neuropsychological testing at the 2 time points a mean (SD) of 5.2 (0.2) years apart. Data analysis was conducted from August 1, 2016, to May 4, 2017. Exposures: The presence, number, and location of L-PVSs. Main Outcomes and Measures: Incident subcortical infarcts, cerebral microbleeds, and progression of white matter hyperintensities detected on MRI; cognitive decline defined as composite score changes between baseline and follow-up in the domains of memory, information processing speed, and executive function; and adjudicated incident dementia cases diagnosed according to international guidelines. Results: Of the 2612 study patients (mean [SD] age, 74.6 [4.8] years; 1542 [59.0%] female), 424 had L-PVSs and 2188 did not. The prevalence of L-PVSs was 16.2% (median number of L-PVSs, 1; range, 1-17). After adjusting for age, sex, and interval between baseline and follow-up scanning, the presence of L-PVSs was significantly associated with an increased risk of incident subcortical infarcts (adjusted risk ratio, 2.54; 95% CI, 1.76-3.68) and microbleeds (adjusted risk ratio, 1.43; 95% CI, 1.18-1.72) and a greater 5-year progression of white matter hyperintensity volume. The presence of L-PVSs was also associated with a steeper decline in information processing speed and more than quadrupled the risk of vascular dementia. All associations persisted when further adjusted for genetic and cerebrovascular risk factors. The associations with cognitive outcomes were independent of educational level, depression, and other SVD MRI markers. Conclusions and Relevance: Large PVSs are an MRI marker of SVD and associated with the pathogenesis of vascular-related cognitive impairment in older individuals. Large PVSs should be included in assessments of vascular cognitive impairment in the older population and as potential targets for interventions.
[Mh] Termos MeSH primário: Doenças de Pequenos Vasos Cerebrais
Demência
Progressão da Doença
Pia-Máter/diagnóstico por imagem
Espaço Subaracnóideo/diagnóstico por imagem
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Envelhecimento
Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem
Doenças de Pequenos Vasos Cerebrais/epidemiologia
Doenças de Pequenos Vasos Cerebrais/fisiopatologia
Demência/diagnóstico por imagem
Demência/epidemiologia
Demência/fisiopatologia
Suscetibilidade a Doenças
Feminino
Seguimentos
Interação Gene-Ambiente
Inquéritos Epidemiológicos
Seres Humanos
Islândia/epidemiologia
Imagem por Ressonância Magnética
Masculino
Prevalência
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171121
[Lr] Data última revisão:
171121
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170718
[St] Status:MEDLINE
[do] DOI:10.1001/jamaneurol.2017.1397


  9 / 442 MEDLINE  
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[PMID]:28600443
[Au] Autor:Hilal S; Mok V; Youn YC; Wong A; Ikram MK; Chen CL
[Ad] Endereço:Memory Aging and Cognition Center, National University Health System, Singapore.
[Ti] Título:Prevalence, risk factors and consequences of cerebral small vessel diseases: data from three Asian countries.
[So] Source:J Neurol Neurosurg Psychiatry;88(8):669-674, 2017 Aug.
[Is] ISSN:1468-330X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cerebral small vessel disease (SVD) has been suggested to be more common in Asians compared with Caucasians. However, data from population-based studies in Asia are lacking. We report on the prevalence, risk factors and consequences of SVD from contemporary studies in three Asian countries using 3-Tesla MRI for the evaluation of SVD. METHODS: Clinical, cognitive and 3-Tesla brain MRI assessments were performed among participants of three studies from Singapore, Hong Kong and Korea. SVD markers include white matter hyperintensities (WMHs) using the modified Fazekas scale, lacunes and microbleeds. Cognition was assessed using the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Adjustments were made for age, sex and cardiovascular risk factors. RESULTS: A total of 1797 subjects were available for analysis (mean age: 70.1±6.3 years and 57% women). The prevalence of confluent WMH was 36.6%, lacunes, 24.6% and microbleeds, 26.9%. Presence of all three SVD markers showed a steeper increase with increasing age rising from 1.9% in the lowest to 46.2% in the highest 5-year age strata. The major risk factors for the increased severity of SVD markers were advancing age and hypertension. Moreover, increasing severity of SVD markers was independently associated with worse performance on MMSE and MoCA. CONCLUSION: Elderly Asians have a high burden of SVD which was associated with cognitive dysfunction. This suggests that SVD markers should be a potential target for treatment in clinical trials so as to delay progression of cerebrovascular disease and potentially cognitive decline.
[Mh] Termos MeSH primário: Doenças de Pequenos Vasos Cerebrais/epidemiologia
Doenças de Pequenos Vasos Cerebrais/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Doenças de Pequenos Vasos Cerebrais/complicações
Doenças de Pequenos Vasos Cerebrais/diagnóstico
Transtornos Cognitivos/diagnóstico
Comparação Transcultural
Feminino
Hong Kong
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
República da Coreia
Fatores de Risco
Singapura
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171114
[Lr] Data última revisão:
171114
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170611
[St] Status:MEDLINE
[do] DOI:10.1136/jnnp-2016-315324


  10 / 442 MEDLINE  
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[PMID]:28566448
[Au] Autor:van Leijsen EMC; de Leeuw FE; Tuladhar AM
[Ad] Endereço:Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Radboud university medical centre, Nijmegen, the Netherlands.
[Ti] Título:Disease progression and regression in sporadic small vessel disease-insights from neuroimaging.
[So] Source:Clin Sci (Lond);131(12):1191-1206, 2017 Jun 01.
[Is] ISSN:1470-8736
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Cerebral small vessel disease (SVD) is considered the most important vascular contributor to the development of dementia. Comprehensive characterization of the time course of disease progression will result in better understanding of aetiology and clinical consequences of SVD. SVD progression has been studied extensively over the years, usually describing change in SVD markers over time using neuroimaging at two time points. As a consequence, SVD is usually seen as a rather linear, continuously progressive process. This assumption of continuous progression of SVD markers was recently challenged by several studies that showed regression of SVD markers. Here, we provide a review on disease progression in sporadic SVD, thereby taking into account both progression and regression of SVD markers with emphasis on white matter hyperintensities (WMH), lacunes and microbleeds. We will elaborate on temporal dynamics of SVD progression and discuss the view of SVD progression as a dynamic process, rather than the traditional view of SVD as a continuous progressive process, that might better fit evidence from longitudinal neuroimaging studies. We will discuss possible mechanisms and clinical implications of a dynamic time course of SVD, with both progression and regression of SVD markers.
[Mh] Termos MeSH primário: Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem
Microvasos/diagnóstico por imagem
Neuroimagem/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Doenças de Pequenos Vasos Cerebrais/epidemiologia
Progressão da Doença
Seres Humanos
Incidência
Hemorragias Intracranianas/diagnóstico por imagem
Leucoencefalopatias/diagnóstico por imagem
Meia-Idade
Valor Preditivo dos Testes
Prognóstico
Remissão Espontânea
Acidente Vascular Cerebral Lacunar/diagnóstico por imagem
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170602
[St] Status:MEDLINE
[do] DOI:10.1042/CS20160384



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