Asymptomatic Cerebral Microbleeds Seen in Healthy Subjects Have a Strong Association With Asymptomatic Lacunar Infarction

Igase, Michiya; Tabara, Yasuharu; Igase, Keiji; Nagai, Takayuki; Ochi, Namiko; Kido, Tomoko; Nakura, Jun; Sadamoto, Kazuhiko; Kohara, Katsuhiko; Miki, Tetsuro

doi:10.1253/circj.cj-08-0764

Cited by 38 publications

(21 citation statements)

References 16 publications

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“…In particular, microbleeds, which are associated with hypertension [43] and with MRI evidence of LI [44], may play a role in the pathogenesis of AD, as they are related to CSF biomarkers (β-amyloid, total tau, tau phosphorylated at threonine 181) and the cognitive profile of AD patients [45]. Further, both in AD [46] and in the ‘neurodegenerative’ type of MCI [47], WMH have been associated with frontal lobe executive dysfunction, which is the cognitive domain that worsened in our MCI-V patients.…”

Section: Discussionmentioning

confidence: 99%

Progressive Gray Matter Atrophy in Lacunar Patients with Vascular Mild Cognitive Impairment

et al. 2010

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Background and Method: We investigated the progression of cognitive and cerebral changes in 30 patients with a first-ever lacunar infarct (LI): 15 with vascular mild cognitive impairment (MCI-V) and 15 without cognitive impairment. All cases were followed up 18 ± 6 months after the stroke and underwent neurological, neuropsychological and MRI assessments at baseline and longitudinally. Results: Differences in the changes in cognitive function over time were observed between the 2 groups, with the MCI-V patients showing slight memory improvements and frontal-lobe-related test impairments from baseline to follow-up evaluations. At baseline, the 2 groups presented similar white matter hyperintensity (WMH) ratings and whole brain gray matter (GM) volumes, and at the follow-up evaluations, both groups had increased WMH lesions and decreased GM volumes; no statistical differences between groups were found. In contrast, a voxel-based morphometry analysis revealed that only MCI-V patients presented clear regional GM volume losses between the first and the second evaluations in cortical (frontal and temporal) and subcortical (pons, cerebellum and caudate) regions. Conclusion: Frontal lobe dysfunction and regional cortical and subcortical GM atrophy best differentiate the clinical course of LI patients with and without cognitive impairment.

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Section: Discussionmentioning

confidence: 99%

Progressive Gray Matter Atrophy in Lacunar Patients with Vascular Mild Cognitive Impairment

et al. 2010

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“…9 Silent cerebral infarcts detected by brain MRI are often accompanied by microbleeds, and are a future risk for clinical stroke. 10,11 A study involving general subjects also showed decreases in cognitive function and activities of daily living, as well as progression of deep white matter lesions, in patients with orthostatic hypotension or hypertension compared with the group with normal orthostatic BP. 6 Other studies have shown progression of cardiovascular remodeling, such as carotid intimal/medial thickening 12 and left ventricular hypertension, 13 in patients with orthostatic hypertension in comparison with a group with normal orthostatic BP.…”

Section: Association With Target Organ Damagementioning

confidence: 99%

Orthostatic Hypertension A Measure of Blood Pressure Variation for Predicting Cardiovascular Risk

Kario

2009

Circ J

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lderly patients with hypertension have various blood pressure (BP) regulation disorders, which are associated with the progression of target organ damage and cardiovascular risk. 1,2 One of these disorders is orthostatic BP dysregulation. In general, orthostatic BP dysregulation presents as the clinical problem "orthostatic hypotension". Orthostatic hypotension is well-recognized as a risk for falls, syncope, and cardiovascular events. 3,4 In contrast, "orthostatic hypertension", which is an increase in BP upon standing, has been infrequently reported. However, studies in recent years have shown that orthostatic hypertension is a new cardiovascular risk factor. [5][6][7][8][9] This review introduces the latest results on orthostatic hypertension, discusses its present status, and provides a new viewpoint. Definition and Prevalence of Orthostatic HypertensionOrthostatic hypotension is generally defined as a decrease in systolic BP (SBP) of at least 20 mmHg upon standing, whereas no consensus has been reached on the definition of orthostatic hypertension. In addition, various examination methods have been used in previous studies for the diagnosis of orthostatic hypertension.A previous study using the active standing test, in which orthostatic hypertension was defined as an increase (mean of increases after 1 and 2 min) of at least 20 mmHg from the BP in the lying position (mean value of 2 measurements) and orthostatic hypotension as a decrease of at least 20 mmHg, showed incidences of 8.7% and 6.0%, respectively, in general subjects. 6 In the Coronary Artery Risk Development in Young Adults (CARDIA) study, young adults were classified according to SBP changes upon standing into groups with orthostatic hypotension (a decrease >5 mmHg), no BP change (from -5 to +5 mmHg), and orthostatic hypertension (an increase >5 mmHg), and the incidences of orthostatic hypotension and hypertension in 2,781 young adults were 26.6% and 16.2%, respectively. 7 In another study, orthostatic hypertension was defined as both BP in the lying position <140/90 mmHg and BP after 1-min standing ≥140/90 mmHg, and the incidence of orthostatic hypertension in 277 diabetic patients (12.6%) was significantly higher than that in 110 non-diabetic controls (1.8%). 8 We performed a 70° head-up tilt (HUT) test for 15 min after a 10-min supine rest. The orthostatic increase in BP (mean SBP from 6 to 10 min after tilting-SBP during 5 min before tilting) was calculated, and SBP increase ≥20 mmHg was defined as orthostatic hypertension and an SBP decrease ≥20 mmHg was defined as orthostatic hypotension. 9 The incidences of orthostatic hypertension and hypotension in elderly patients with hypertension were 11% and 9.5%, respectively. New Device for Evaluating Orthostatic BP Dysregulation at HomeBecause orthostatic BP changes are markedly affected by the circulating blood volume, their reproducibility is considered to be poor. Therefore, it is optimal to diagnose orthostatic hypertension by performing the orthostatic test more than once. However, in daily ...

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“…The association between SBI and cMBs were suggested in one cross-sectional study. 75 The prevalence of cMBs in normal healthy subjects was 5.6% (mean age, 67.6 ± 7.8 years; range, 38-91). Among the various risk factors, silent lacunar infarction was a major risk factor for the occurrence of cMBs (OR = 5.813; 95% CI: 2.037-16.59; P = 0.001).…”

Section: Clinical Signficance Clinically Overt Strokementioning

confidence: 89%

Risk of “silent stroke” in patients older than 60 years: risk assessment and clinical perspectives

Lim¹,

Kwon²

2010

CIA

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Abstract:With the increasing size of the elderly population and evolving imaging technology, silent brain infarction (SBI) has garnered attention from both the public and the physicians. Over 20% of the elderly exhibit SBI, and the prevalence of SBI increases steadily with age, ie, 30%-40% in those older than 70 years. Well-known cardiovascular risk factors such as hypertension has been identified as a risk factor of SBI (odds ratio [OR] = 3.47) Besides this, blood pressure (BP) reactivity to mental stress, morning BP surges, and orthostatic BP changes have been demonstrated to contribute to the presence of SBI. Further, a metabolic syndrome not only as a whole syndrome (OR = 2.18) but also as individual components could have an influence on SBI. Increased C-reactive protein and interleukin-6, coronary artery disease, body mass index, and alcohol consumption have also been associated with SBI. The ORs and possible mechanisms have been discussed in this article. Overt stroke, dementia, depression, and aspiration pneumonia were all associated with SBI. (overt stroke: hazard ratio [HR] = 1.9, 95% confidence interval [CI]: 1.2-2.8; dementia: HR = 2.26, 95% CI: 1.09-4.70). We also looked into their close relationship with SBI in this review.

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Asymptomatic Cerebral Microbleeds Seen in Healthy Subjects Have a Strong Association With Asymptomatic Lacunar Infarction

Cited by 38 publications

References 16 publications

Progressive Gray Matter Atrophy in Lacunar Patients with Vascular Mild Cognitive Impairment

Progressive Gray Matter Atrophy in Lacunar Patients with Vascular Mild Cognitive Impairment

Orthostatic Hypertension A Measure of Blood Pressure Variation for Predicting Cardiovascular Risk

Risk of “silent stroke” in patients older than 60 years: risk assessment and clinical perspectives

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Asymptomatic Cerebral Microbleeds Seen in Healthy Subjects Have a Strong Association With Asymptomatic Lacunar Infarction

Cited by 38 publications

References 16 publications

Progressive Gray Matter Atrophy in Lacunar Patients with Vascular Mild Cognitive Impairment

Progressive Gray Matter Atrophy in Lacunar Patients with Vascular Mild Cognitive Impairment

Orthostatic Hypertension A Measure of Blood Pressure Variation for Predicting Cardiovascular Risk

Risk of &ldquo;silent stroke&rdquo; in patients older than 60 years: risk assessment and clinical perspectives

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Risk of “silent stroke” in patients older than 60 years: risk assessment and clinical perspectives