Brain magnetic resonance imaging abnormalities in patients with heart failure

BACKGROUND: Although heart failure (HF) is a common cardiovascular disorder, to date little research has been conducted into possible associations between HF and structural abnormalities of the brain. AIMS: To determine the frequency and pattern of magnetic resonance imaging (MRI) abnormalities in outpatients with chronic HF, and to identify any demographic and clinical correlates. METHODS: Brain MRI scans were compared between a sample of 58 HF patients, 48 controls diagnosed with cardiovascular disease uncomplicated by HF (cardiac controls) and 42 healthy controls. Deep, periventricular and total white matter hyperintensities (WMH), lacunar and cortical infarcts, global and medial temporal lobe atrophy (MTA) were investigated. RESULTS: Compared to cardiac and healthy controls, HF patients had significantly more WMH, lacunar infarcts and MTA, whereas cardiac controls only had more MTA, compared to healthy controls. Age and left ventricular ejection fraction (LVEF) were independently associated with total WMH. Age and systolic hypotension were associated with MTA in HF patients and cardiac controls. CONCLUSION: Our results suggest that cardiac dysfunction contributes independently to the development of cerebral MRI abnormalities in patients with HF. Age and low LVEF are the principal predictors of cerebral WMH in patients with HF and in cardiac controls.     

Cognitive impairment and MRI correlates in the elderly patients with type 2 diabetes mellitus

BACKGROUND: exact mechanisms underlying cognitive dysfunction in diabetes mellitus (DM) remain unclear. Imaging studies of the brain could help to identify possible structural brain lesions underlying cognitive dysfunction. OBJECTIVE: to describe a detailed neuropsychological profile in patients functioning independently with type 2 DM. Secondly, correlations were studied between cognitive impairment and brain lesions on magnetic resonance imaging (MRI), i.e. periventricular hyperintensities (PVH), deep white matter lesions (DWML), medial temporal lobe atrophy (MTA), cerebral atrophy and lacunar infarcts. In addition, the influence of relevant disease variables of DM was studied. METHODS: 92 patients with type 2 DM (mean age 73.2 +/- 5.7 years, mean duration 13.8 +/- 10.8 years) and 44 control subjects (mean age 72.9 +/- 5.3 years) were included and underwent an extensive neuropsychological test battery and an MRI of the brain. RESULTS: neuropsychological scores were worse for each cognitive domain except for memory functions after adjustment for hypertension in a group of elderly patients with type 2 DM compared to healthy control subjects. Only PVH were independently associated with motor speed, whereas all other MRI measures were not independently associated with cognitive impairment. Interactions between the different MRI measures were not present. Glycosylated haemoglobin (HbA(1c)) and duration of DM were significantly associated with cognitive dysfunction. CONCLUSIONS: the data of this cross-sectional study show that type 2 DM is associated with diminished cognitive function in different cognitive domains, while memory is less affected after adjustment for hypertension. The association of cognitive impairment with MRI measures is equivocal, whereas HbA(1c) and duration of DM were significantly associated with cognitive dysfunction.     

The relation between antihypertensive treatment and progression of cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials

Background:Cerebral small vessel disease is relevant to hypertension. We tried to figure out whether antihypertensive treatment is beneficial for this disease.Methods:We systematically searched PubMed, Embase, and Cochrane electronic databases for randomized controlled trials about white matter hyperintensities (WMH), brain atrophy, microbleeds, and lacunar infarcts with antihypertensive treatment and performed a meta-analysis.Results:We identified 7 trials on white matter hyperintensities and brain atrophy with antihypertensive treatment. Pooled analysis showed antihypertensive treatment performed positively in the progression of WMH (standardized mean difference, −0.22; 95% CI, −0.36 to −0.07, I^2 = 52%). And in the subgroup meta-analysis, only lower SBP controlled level (110–129 mm Hg) had effect on the progression of WMH (standardized mean difference, −0.37; 95% CI, −0.54 to −0.29, I^2 =0). The meta-regression showed larger difference of SBP in treatment groups having a smaller WMH progression. Antihypertensive treatment is not significant in the progression of brain atrophy (standardized mean difference, −0.02; 95% CI, −0.26 to 0.30, I^2 = 85%). Only 1 trial reported the new patients of lacunar infarcts in the follow-up, no association with antihypertensive treatment (odds ratio, 2.2; 95% CI, 0.4–12.1; P = .36).Conclusions:Antihypertensive treatment is beneficial for cerebral small vessel disease on white matter hyperintensities progression, but no impact on brain atrophy. And lower SBP level is more effective on the progression of WMH. There is not enough evidence to prove the relationship between antihypertensive treatment and lacunar stroke, microbleeds.     

Relation between the clock drawing test (CDT) and structural changes of brain in dementia

The CDT is a useful screening instrument for assessing cognition. The aim of this study is to identify which structural change of the brain is related with the CDT performance. Eighty-four patients with memory impairment were enrolled. The Korean versions of the mini-mental state examination (K-MMSE) and the modified mini-mental state (3MS) test, and the Seoul Neuropsychological Screening Battery (SNSB) were given to every subject. Four CDT scoring methods were used. The cerebral white matter hyperintensity (WMH), cortical atrophy (CA), ventricular enlargement (VE), and medial temporal lobe atrophy (MTA) were rated by two neurologists who were kept "blind" to the clinical information. The cognitive and executive functions were significantly correlated with the CDT performance. The degree of WMH and MTA showed an inverse relation with the CDT performance. The periventricular WMH (PVH) contributed more to impairment of CDT, than that of the deep WMH (DWMH). This study suggests that a combination of executive dysfunction via the frontal-subcortical disruption due to the PVH and memory impairment due to the MTA might be responsible for further worsening on the CDT.     

Cerebral white matter hyperintensity is mainly associated with hypertension among the components of metabolic syndrome in Koreans

Background  Cerebral white matter hyperintensity (WMH) is a common abnormality in brain magnetic resonance imaging (MRI) and is known to be associated with ischaemic stroke. Previous studies revealed that the risk factors for cerebral WMH were age, female gender, hypertension and diabetes. In this study we examined the association between cerebral WMH and metabolic syndrome, a cluster of hypertension, glucose intolerance, abdominal obesity and dyslipidaemia.
Methods and results  We reviewed the results of brain MRI of 5498 subjects who underwent routine check-ups including laboratory tests at the Seoul National University Health Care System. Among the subjects who met the inclusion criteria ( n  = 5104), 1693 (33·2%) had cerebral WMH. They were characterized by old age, female predominance, higher body mass index (BMI), larger waist circumference, higher blood pressure, higher fasting plasma glucose level, and higher haemoglobin A1c (HbA1c). In multivariate analyses, age, female gender and hypertension were the independent risk factors for cerebral WMH. Metabolic syndrome was associated with cerebral WMH after adjusting for age and gender [odds ratio (OR) 1·20, 95% confidence interval (CI) 1·04–1·39, P  = 0·014]. Among the components of metabolic syndrome, hypertension was independently associated with cerebral WMH (OR 1·20, 95% CI 1·05–1·38, P  = 0·007).
Conclusion  Age, female gender and hypertension were risk factors for cerebral WMH in the Korean population. Cerebral WMH was also associated with metabolic syndrome; however, metabolic syndrome offered no advantage over hypertension alone in predicting cerebral WMH.     

2型糖尿病患者认知功能障碍与脑白质高信号负荷及分布特征的相关性

目的探讨2型糖尿病（T2DM）患者认知功能障碍与脑白质高信号（WMH）负荷及分布特征的关系。 方法2013—2015年，从华中科技大学同济医学院附属同济医院招募年龄匹配的T2DM患者40例，健康对照者20例（健康对照组）。T2DM患者中有轻度认知功能障碍（MCI）者20例（T2DM伴MCI组），无MCI者20例（T2DM无MCI组）。采用Fazekas量表（FS）及改良Scheltens量表（MSS）进行磁共振WMH视觉评估，对比3组WMH负荷及分布特征差异，并采用Spearman相关性分析法分析WMH负荷与认知功能评分之间的相关性。随访5年后对比健康对照者与T2DM患者的WMH负荷、分布区域及认知功能变化情况。组间比较采用方差分析、秩和检验及χ²检验。 结果3组研究对象FS、MSS评分的差异有统计学意义（F=8.600、9.176，P<0.01），其中T2DM患者明显高于健康对照组（P<0.05或0.01）。3组研究对象脑室周、额叶、基底节、颞叶、枕叶MSS评分的差异有统计学意义（F=12.069、6.575、8.358、4.869、6.037，P<0.01），其中T2DM患者高于健康对照组（P<0.05或0.01），且T2DM伴MCI组基底节区、颞叶、枕叶的MSS评分均明显高于T2DM无MCI组（P<0.05）。认知功能评分与WMH负荷呈负相关（P<0.05或0.01）。相对于5年前，健康对照者简易智能精神状态检查量表评分明显降低（t=3.167，P<0.01）；健康对照者及T2DM患者的蒙特利尔认知评估量表评分均明显降低（t=5.734、3.863，P<0.01），FS及MSS评分均明显增高（FS评分：t=3.811、4.564，MSS评分：t=4.839、6.010，P<0.01）。 结论T2DM患者认知功能障碍与WMH密切相关，磁共振WMH负荷及脑区分布特征可能作为T2DM患者认知功能障碍评估潜在的影像标志物。     

Blood Pressure Variation and Subclinical Brain Disease

BackgroundLarge blood pressure (BP) variability may contribute to stroke and dementia, but the mechanisms are largely unknown.ObjectivesThis study investigated the association of BP variation, considering its magnitude and direction, with the presence and progression of subclinical brain disease in the general population.MethodsThis study included 2,348 participants age ≥55 years from a prospective cohort study. BP was measured at each visit every 3 to 4 years from 1990 onward. Brain magnetic resonance imaging (MRI) was performed at all visits from 2005 onward. The authors primarily assessed variation as the absolute difference in BP divided by the mean over 2 sequential visits for both systolic BP (SBP) and diastolic BP (DBP), and further assessed the direction of the variation. The authors investigated the multivariate-adjusted associations of BP variation with subsequent measurements of MRI markers of cerebral small vessel disease, brain tissue volumes, and white matter microstructural integrity. Longitudinal changes in these markers also were assessed.ResultsA large SBP variation (top vs. bottom tertiles), measured on average 7 years preceding brain MRI, was associated with higher odds of having severe white matter hyperintensities (WMH) (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.21 to 1.43), lacunes (OR: 1.25; 95% CI: 1.04 to 1.48), and microbleeds (OR: 1.16; 95% CI: 1.03 to 1.31). Similarly, this variation was associated with smaller total brain volume and worse white matter microstructural integrity (all p < 0.001). A large SBP variation was also associated with the progression of WMH (rate ratio [RR]: 1.14; 95% CI: 1.02 to 1.27). Higher burdens of these brain imaging markers were observed with both large rises and falls in SBP. Similar findings were observed for DBP variation.ConclusionsElevated BP variation was associated with a wide range of subclinical brain structural changes, including MRI markers of cerebral small vessel disease, smaller brain tissue volumes, and worse white matter microstructural integrity. These subclinical brain changes could be the underlying mechanisms linking BP variation to dementia and stroke.     

The brain reserve hypothesis, brain atrophy and aging

BACKGROUND: Researchers have used the concept of brain reserve to explain the dissociation between pathological brain damage and cognitive and functional performance. A variety of brain reserve hypotheses exist, and different empirical strategies have been employed to investigate these variants. OBJECTIVE: The study investigates (i) the relationship between measures of brain burden (atrophy, white matter hyperintensities (WMH)) and measures of reserve (education, creativity, and intelligence); (ii) the relationship between cognitive decline and reserve; (iii) whether measures of reserve mediate the effect of atrophy on estimated cognitive change, and (iv) the association between brain risk factors, education and atrophy. METHODS: A cross-sectional study of a sample of 446 individuals 60-64 years of age who underwent MRI scans as part of a large epidemiological study. Measures were taken of education, intelligence, creativity, cognitive speed, brain volume, WMH, estimated cognitive decline from earlier in life and brain atrophy. RESULTS: No association was found between estimated cognitive decline and brain burden (atrophy, WMH). Risk factors for brain insult were not associated with greater brain atrophy in the less well educated. Neither education, nor any other measure including intelligence or creativity, provided a buffer for cognitive decline in individuals with high levels of brain atrophy. CONCLUSION: Little support was found for the brain reserve hypothesis.     

脑小血管病与轻度认知功能障碍的关系

目的探讨脑小血管病变（SVD）与轻度认知功能障碍（MCI）的关系。方法收集临床SVD相关的MCI（SVD-MCI）患者66例和认知功能正常的老年人57例作为对照组。根据视觉评分,评估白质病变（WML）和内侧颞叶萎缩（MTA）病变的程度,并记录大脑不同部位腔隙性梗死（LI）的数目,应用多元Logistic回归分析LI、WML和MTA与SVD-MCI之间的相关性。结果①与对照组相比,SVD-MCI组患者患高血压比例和血中TC含量明显升高（P〈0.05）;吸烟、患糖尿病的比例和血中总胆固醇、低密度脂蛋白胆固醇含量有所升高,但差异无统计学意义（P〉0.05）;②与对照组相比,SVD-MCI组患者丘脑、侧脑室周围白质和皮质下白质LI的数目明显增加（P〈0.05）;SVD-MCI组患者侧脑室周围和皮质下WML以及双侧MTA评分分值也显著增加（P〈0.05）;③控制了年龄和多种血管危险因素的影响之后,多元Logistic回归分析显示,丘脑LI、侧脑室旁WML和左侧MTA与SVD-MCI相关。结论丘脑LI、侧脑室旁WML和左侧MTA可能是SVD-MCI的独立危险因素,积极预防和治疗SVD,也许可降低MCI的发生率。     

Prediabetes and structural brain abnormalities: Evidence from observational studies

Type 2 diabetes mellitus has been linked to structural brain abnormalities, but evidence of the association among prediabetes and structural brain abnormalities has not been systematically evaluated. Comprehensive searching strategies and relevant studies were systematically retrieved from PubMed, Embase, Medline and web of science. Twelve articles were included overall. Stratified analyses and regression analyses were performed. A total of 104 468 individuals were included. The risk of infarct was associated with continuous glycosylated haemoglobin (HbA_1c) [adjusted odds ratio (OR) 1.19 (95% confidence interval [CI]: 1.05‐1.34)], or prediabetes [adjusted OR 1.13 (95% CI: 1.00‐1.27)]. The corresponding ORs associated with white matter hyperintensities were 1.08 (95%CI: 1.04‐1.13) for prediabetes, and 1.10 (95%CI: 1.08‐1.12) for HbA_1c. The association was significant between the decreased risk of brain volume with continuous HbA_1c (the combined OR 0.92, 95% CI: 0.87‐0.98). Grey matter volume and white matter volume were inversely associated with prediabetes [weighted mean deviation (WMD), ?9.65 (95%CI: ?15.25 to ?4.04) vs WMD, ?9.25 (95%CI: ?15.03 to ?3.47)]. There were no significant association among cerebral microbleeds, hippocampal volume, continuous total brain volume, and prediabetes. Our findings demonstrated that (a) both prediabetes and continuous HbA_1c were significantly associated with increasing risk of infarct or white matter hyperintensities; (b) continuous HbA_1c was associated with a decreased risk of brain volume; (c) prediabetes was inversely associated with grey matter volume and white matter volume. To confirm these findings, further studies on early diabetes onset and structural brain abnormalities are needed.     

High serum alkaline phosphatase in relation to cerebral small vessel disease

Objectives

Vascular calcification is related with cerebral small vessel disease. We investigated whether alkaline phosphatase (ALP), a marker of vascular calcificiation, is related to cerebral small vessel disease.

Methods

We included 1082 neurologically healthy subjects who underwent brain magnetic resonance image for a routine health checkup. ALP levels were divided into quartiles. We used quantile regression and logistic regression to evaluate the associations of ALP with white matter hyperintensities (WMH), cerebral infarct and cerebral microbleeds.

Results

Subjects with higher ALP were more likely to have a large WMH volume. The adjusted difference of WMH volume between the highest and the lowest quartiles was 0.27 mL (95% confidence interval [CI]; 0.22–0.31 mL). In addition, cerebral infarct was more prevalent in subjects with higher ALP. Compared to the lowest quartile, adjusted odds ratios of having cerebral infarct for the highest quartile was 2.60 (95% CI, 1.10–6.10). No association was found between ALP and cerebral microbleeds. In addition, we found a conjoint effect of ALP and C-reactive protein(CRP) on cerebral small vessel disease. Compared with subjects with low ALP (≤63 IU/L) and low CRP (≤0.5 mg/dl), those with high ALP (>63 IU/L) and high CRP (>0.5 mg/dl) had larger WMH volume (adjusted difference 0.39 mL; 95% CI 0.37–0.42 mL) and a 3-fold (adjusted OR. 3.37; 95% CI, 1.61–7.03) risk of cerebral infarct.

Conclusion

We found that higher serum levels of ALP are independently associated with WMH and cerebral infarct, but not with cerebral microbleeds.     

深部髓质静脉可见性与脑小血管病影像学标志物及总负荷的关系研究

背景 深部髓质静脉(DMV)因具有便于观察和结构相对稳定的优势,已成为目前研究脑小血管病(CSVD)与静脉之间关系的切入点.目的 分析DMV可见性与CSVD影像学标志物及总负荷评分的关系.方法 选取2019年1月至2021年6月在徐州医科大学附属医院完成颅脑磁共振成像(MRI)、磁敏感加权成像(SWI)、头颈磁共振血管...     

White matter hyperintensity load varies depending on subjective cognitive decline criteria

GeroScience - Increased age and cognitive impairment is associated with an increase in cerebrovascular pathology often measured as white matter hyperintensities (WMHs) on MRI. Whether WMH burden...     

Midlife blood pressure and the risk of hippocampal atrophy: the Honolulu Asia Aging Study

Hippocampal atrophy (HA) is usually attributed to the neurofibrillary tangles and neuritic plaques of Alzheimer disease. However, the hippocampus is vulnerable to global ischemia, which may lead to atrophy. We investigated the association of midlife blood pressure (BP) and late-life HA in a sample of Japanese-American men born between 1900 and 1919. BP was measured on 3 occasions between 1965 and 1971. In 1994 to 1996 a subsample underwent magnetic resonance imaging (MRI) of the brain. Hippocampal volume was estimated by manually drawing regions of interest on relevant scan slices; HA was defined as the lowest quartile of hippocampal volume. Also assessed on the MRI were cortical and subcortical infarcts, lacunes, and white matter hyperintensities. The risk (OR, 95% CI) was estimated for HA associated with systolic (<140 versus > or =140 mm Hg) and diastolic (<90 versus > or =90 mm Hg) BP and with antihypertensive treatment. Analyses were adjusted for sociodemographic factors, other cardiovascular risk factors, apolipoprotein E allele, and correlated brain pathology. Those never treated with antihypertensive medication had a significantly increased risk for HA (OR 1.7; CI=1.12; 2.65). The nontreated subjects with high systolic BP had an increased risk (OR=1.98; CI=0.89; 4.39) for HA. Results were similar for untreated men with high diastolic BP (OR=3.51; CI=1.26; 9.74). In conclusion, treatment with antihypertensive treatment modifies the association of BP and HA, such that high levels of BP adversely affect the hippocampus in persons never treated with antihypertensives.     

Structural abnormality on brain magnetic resonance imaging in late-onset major depressive disorder

The purpose of this study was to examine the structural abnormalities of patients with late-onset major depressive disorder using brain magnetic resonance imaging (MRI) and to assess clinical correlates of these structural abnormalities. Thirty-seven elderly patients with DSM-IV major depressive disorder that first occurred after the age of 50 years, and 18 control subjects without depression were recruited. All participants underwent comprehensive psychiatric assessment and cerebral MRI. Brain ventricular and sulcal sizes and white matter hyperintensities were assessed visually. Relative to control subjects, patients with late-life major depressive disorder showed more severe brain atrophy (p = 0.043) and white matter hyperintensities (p = 0.024), especially in the periventricular area (p = 0.012). Over 60% of the patient group had significant brain MRI hyperintensities. White matter hyperintensity was correlated with later onset of depressive illness (r = 0.49, p = 0.002) among patients. Brain atrophy and white matter hyperintensities are prevalent in patients with late-onset major depressive disorders. These two abnormalities may represent different pathophysiologic processes of depressive disorders. White matter hyperintensities may be predisposing factors for late-onset major depressive disorder.     

White Matter Hyperintensities Predict Functional Decline in Voiding,Mobility, and Cognition in Older Adults

OBJECTIVES: To compare magnetic resonance imaging data with functional assessments of mobility, urinary control, and cognition to determine common or distinctive features in the distribution of brain white matter hyperintensities (WMHs) associated with functional decline and impairment. DESIGN: Baseline data from subjects aged 75 to 89 enrolled in a longitudinal study. Assessors and subjects were blinded to group assignment. SETTING: Healthy community‐dwelling volunteers. PARTICIPANTS: Ninety‐nine subjects were enrolled using a balanced 3 × 3 matrix stratified according to age and mobility performance. Exclusion criteria were medication, systemic conditions, and neurological diseases that can compromise mobility. MEASUREMENTS: WMHs were identified using a semi‐automated segmentation method, and regional burdens were assessed using a white matter parcellation atlas. Quantitative measures of mobility, urinary incontinence (UI) severity, and executive function and processing speed were obtained. RESULTS: WMHs occur predictably in predominantly periventricular areas. There were powerful correlations between total (tWMH) and regional (rWMH) WMH, with correlation coefficients of 0.5 to 0.9 for eight of 10 structures analyzed. tWMH predicted functional measures of UI, mobility, executive function, and processing speed nearly as well as the best regional measures. The total volume of WMHs independently explains 5% to 11% of the variability for mobility, UI severity, executive function, and processing speed and is a sensitive (0.7–0.8) predictor of functional decline. The odds of decline in each of the three functional domains was 1.5 to 2.4 times greater with each 1% increase in tWMH. CONCLUSION: This work establishes the importance of brain WMH burden in three major geriatric syndromes. The findings support the inclusion of total WMH burden as a risk factor in the predictive and diagnostic criteria.     

Do white matter changes have clinical significance in Alzheimer's disease?

BACKGROUND: Although white matter changes visible with MRI are generally considered to result from ischemia, it has become clear that these changes also appear in patients with Alzheimer's disease (AD). However, their significance in AD is unknown. OBJECTIVE: We evaluated the clinical significance of white matter changes in AD. METHODS: Ninety-six AD patients (79.4 +/- 5.92 years old) and 48 age-matched control subjects (80.0 +/- 7.03 years old) participated in the study. Three neuroradiologists assessed the degree of periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) using a modified Fazekas' rating scale. We examined whether there was a difference in the severity and the histogram pattern of the white matter changes, or in vascular factors (hypertension, diabetes mellitus, and ischemic heart disease) between the two groups. We also analyzed the association between the severity of the white matter changes and the degree of dementia (MMSE score and disease duration). RESULTS: There were no differences in the vascular factors between AD and control subjects. The degree of PVH in AD was severe compared with that in the control subjects. In histograms of the number of subjects with each degree of PVH severity, the distribution of AD patients had peaks at both the low and intermediate degrees of PVH, while most of the controls had a low degree of PVH. There was no difference in the degree or the histogram pattern of DWMH between the two groups. The severity of white matter changes was not associated with severity of dementia in AD. CONCLUSIONS: Although PVH might have several causative factors, and may have some clinical significance, the change itself does not contribute to the progression of AD.     

Medial temporal lobe atrophy in vascular dementia: visual temporal lobe rating scale

Medial temporal lobe atrophy (MTA) as assessed by magnetic resonance imaging (MRI) can be measured in several ways. First of all, visual rating scale is a quick and easy measurement. MTA is a sensitive marker for Alzheimer's disease (AD), but not specific. It has been documented in other dementias including vascular dementia (VD). This study is to evaluate the degree of MTA in VD patients using a standardized visual rating scale and to suggest the importance of the possible role of MTA in VD. Twenty-five VD, 33 AD and 27 non-demented patients underwent a coronal three-dimensional magnetization prepared rapid gradient echo brain MRI sequence. MTA was rated visually using a 5-point rating scale from 0 (no atrophy) to 4 (severe atrophy). The mean summed MTA score was 5.39 in AD, 2.16 in VD and 0.56 in non-demented patients. Most of the VD patients (80%) showed MTA. They were greater in bilateral sides compared with the non-demented group, but milder than in AD. Additionally, MTA of left side score was significantly associated with age. Medial temporal lobe volumes measured visually are smaller in size in patients with VD, although not to the same extent as in AD. This suggests that MTA in VD patients may be associated with pre-existing AD.     

White matter hyperintensities (WMH) are associated with intracranial atherosclerosis rather than extracranial atherosclerosis

There is increasing evidence for an association between WMH and large-artery atherosclerosis. We evaluated 268 patients with acute ischemic stroke to assess the relationship between intracranial (IC) atherosclerosis and WMH. The patients were classified into three groups according to the location of the stenosis; IC, extracranial (EC), and non-stenosis (NS) group. WMH were rated using the semiquantitative method of Scheltens and coworkers. The IC group had significantly more WMH score in comparison with the other groups after controlling age. The linear regression analysis showed that age was the factor most strongly associated with the total score of WMH; and the location of stenosis was positively related to WMH, especially in deep white matter. Our data show that IC stenosis is associated with WMH, indicating that IC stenosis, rather than EC stenosis, is likely to cause white matter lesions. These findings raise the possibility that occlusion of penetrating arteries, embolism to border-zone areas and a hemodynamic mechanism associated with IC stenosis leads to the formation of white matter lesions.     

Peripheral arterial disease and depressed mood in older men and women

The objective of this study was to determine whether lower extremity peripheral arterial disease (PAD) is associated with depressive symptoms and whether PAD-related disability mediates the association between PAD and depressive symptoms. The study used a cross-sectional design set in an academic medical center. A cohort of men and women aged 55 years and older with (n = 93) or without (n = 74) PAD was recruited. PAD subjects were identified from a blood flow laboratory and a general medicine practice. Non-PAD subjects were identified from the same general medicine practice. PAD was diagnosed and quantified using the ankle-brachial index (ABI). Depressive symptoms were assessed by the 15-item short version of the Geriatric Depression Scale (GDS-S; score range 0-15, 0 = no depressive symptoms). The six-minute walk test and the Walking Impairment Questionnaire (WIQ) distance score (score range 0-100, 100 = better walking ability) were measures of walking impairment. PAD subjects had depressive mood (DM) (defined by GDS-S score >5) twice as often as controls (24% vs 12%, p = 0.06). After adjustment for age, education, and number of comorbidities, the prevalence of depressive mood among PAD subjects was increased, but this association was not significant (OR = 1.8, 95% CI 0.7-4.4). The WIQ distance score weakened the association between PAD and DM, and higher distance scores were associated with a lower likelihood of DM (OR = 0.98 per one unit of the WIQ, 95% CI 0.96-0.99). Among PAD subjects, severe PAD (ABI <0.5) was not significantly associated with DM (OR = 1.4, 95% CI 0.5-4.1), but a greater 6-min walk distance was associated with a lower likelihood of DM (OR = 0.8 per 100 feet, 95% CI 0.70-0.97). Substituting the WIQ scores for six-min walk distance in the model showed that higher WIQ scores were associated with lower likelihood of DM among PAD subjects (OR= 0.98 per one unit of the WIQ, 95% CI 0.95-1.0), though the association did not achieve statistical significance. In conclusion, these data suggest that PAD may be associated with an increased risk of DM and that this relationship may be related to PAD-associated disability. An evaluation for depression may be appropriate in men and women with PAD. Findings should be evaluated in a larger study cohort.