Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease

Rydén, Lina; Sacuiu, Simona; Wetterberg, Hanna; Najar, Jenna; Guo, Xinxin; Kern, Silke; Zettergren, Anna; Shams, Sara; Pereira, Joana B.; Wahlund, Lars‐Olof; Westman, Eric; Skoog, Ingmar

doi:10.1212/wnl.0000000000012675

Cited by 31 publications

(17 citation statements)

References 43 publications

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“…There is an association between atrial fibrillation, load of subcortical infarcts, and WMH [29], but direct evidence of embolism is lacking. Multiple RSSIs do not exclude mechanisms related to SVD (about 20% of RSSI present multiple infarcts, especially in patients with severe SVD [30]).…”

Section: Microembolismsmentioning

confidence: 99%

The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke

Rudilosso

Rodríguez-Vázquez

Urra

et al. 2022

IJMS

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Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral small vessel disease. The pathophysiological mechanisms leading to a perforating artery occlusion are multiple and still not completely defined, due to spatial resolution issues in neuroimaging, sparsity of pathological studies, and lack of valid experimental models. Recent advances in the endovascular treatment of large vessel occlusion may have diverted attention from the management of patients with small vessel occlusions, often excluded from clinical trials of acute therapy and secondary prevention. However, patients with a lacunar stroke benefit from early diagnosis, reperfusion therapy, and secondary prevention measures. In addition, there are new developments in the knowledge of this entity that suggest potential benefits of thrombolysis in an extended time window in selected patients, as well as novel therapeutic approaches targeting different pathophysiological mechanisms involved in small vessel disease. This review offers a comprehensive update in lacunar stroke pathophysiology and clinical perspective for managing lacunar strokes, in light of the latest insights from imaging and translational studies.

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Section: Microembolismsmentioning

confidence: 99%

The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke

Rudilosso

Rodríguez-Vázquez

Urra

et al. 2022

IJMS

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“…The presence/absence of cerebral microbleeds was visually assessed on SWI, lacunes (3–15 mm) were assessed on FLAIR images, and superficial siderosis was assessed on SWI. All visual assessments were performed by an experience neuroradiologist blinded to clinical data, 19 according to the Standards for Reporting Vascular Changes on Neuroimaging and standard scales and standardized scales. 20 We also recorded and described the frequency of vascular risk factors, including hypertension, diabetes, smoking, and ischemia as assessed through a semistructured interview and clinical examination by research nurses or medical doctors.…”

Section: Methodsmentioning

confidence: 99%

Association of Cerebrovascular and Alzheimer Disease Biomarkers With Cholinergic White Matter Degeneration in Cognitively Unimpaired Individuals

et al. 2022

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Objectives:Several pathological processes might contribute to the degeneration of the cholinergic system in aging. We aimed to determine the contribution of amyloid, tau, and cerebrovascular biomarkers towards the degeneration of cholinergic white matter (WM) projections in cognitively unimpaired individuals.Methods:The contribution of amyloid and tau pathology was assessed through cerebrospinal fluid (CSF) levels of the Aβ42/40 ratio and phosphorylated tau (p-tau). CSF Aβ38 levels were also measured. Cerebrovascular pathology was assessed using automatic segmentations of WM lesions on magnetic resonance imaging (MRI). Cholinergic WM projections (i.e., cingulum and external capsule pathways) were modeled using tractography based on diffusion tensor imaging data. Sex and APOE 𝜀4 carriership were also included in the analysis as variables of interest.Results:We included 203 cognitively unimpaired individuals from the H70 Gothenburg Birth Cohort Studies (all individuals 70 years old, 51% female). WM lesion burden was the most important contributor to the degeneration of both cholinergic pathways (Increase in mean square error (IncMSE)=98.8% in external capsule pathway and IncMSE=93.3% in the cingulum pathway). Levels of Aβ38 and p-tau also contributed to cholinergic white matter degeneration, especially in the external capsule pathway (IncMSE=28.4% and IncMSE=23.4%, respectively). The Aβ42/40 ratio did not contribute notably to the models (IncMSE<3.0%). APOE 𝜀4 carriers showed poorer integrity in the cingulum pathway (IncMSE=21.33%). Women showed poorer integrity of the external capsule pathway (IncMSE=21.55%), which was independent of amyloid status as reflected by the non-significant differences in integrity when comparing amyloid positive versus amyloid negative women participants (T201=-1.55; p=0.123).Conclusions:In cognitively unimpaired older individuals, WM lesions play a central role in the degeneration of cholinergic pathways. Our findings highlight the importance of WM lesion burden in the elderly population, which should be considered in the development of prevention programs for neurodegeneration and cognitive impairment.

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“…Standardized WMH volume = actual WMH volume/ total intracranial volume ( 42 ). WMH volume (‰) was used to represent the standardized WMH volume in our study.…”

Section: Methodsmentioning

confidence: 99%

Retinal thickness changes in different subfields reflect the volume change of cerebral white matter hyperintensity

Teng²,

Jia³

et al. 2022

Front. Neurol.

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PurposeTo investigate the relationship between the retinal thickness in different subfields and the volume of white matter hyperintensity (WMH), with the hope to provide new evidence for the potential association between the retina and the brain.MethodsA total of 185 participants aged over 40 years were included in our study. Magnetic resonance imaging (MRI) was used to image the WMH, and WMH volume was quantitatively measured by a specific toolbox. The thickness of the total retina, the retinal nerve fiber layer (RNFL), and the ganglion cell and inner plexiform layer (GCIP) was measured by optical coherence tomography (OCT) in nine subfields. The association between retinal thickness and WMH volume was demonstrated using binary logistic regression and Pearson correlation analysis.ResultsParticipants were divided into two groups by the WMH volume (‰, standardized WMH volume) median. In the quartile-stratified binary logistic regression analysis, we found that the risk of higher WMH volume showed a positive linear trend correlation with the thickness of total retina (95% CI: 0.848 to 7.034; P for trend = 0.044)/ GCIP (95% CI: 1.263 to 10.549; P for trend = 0.038) at the central fovea, and a negative linear trend correlation with the thickness of nasal inner RNFL (95% CI: 0.086 to 0.787; P for trend = 0.012), nasal outer RNFL (95% CI: 0.058 to 0.561; P for trend = 0.004), and inferior outer RNFL (95% CI: 0.081 to 0.667; P for trend = 0.004), after adjusting for possible confounders. Correlation analysis results showed that WMH volume had a significant negative correlation with superior outer RNFL thickness (r = −0.171, P = 0.02) and nasal outer RNFL thickness (r = −0.208, P = 0.004).ConclusionIt is suggested that central fovea and outer retina thickness are respectively associated with WMH volume. OCT may be a biological marker for early detection and longitudinal monitoring of WMH.

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Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease

Cited by 31 publications

References 43 publications

The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke

The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke

Association of Cerebrovascular and Alzheimer Disease Biomarkers With Cholinergic White Matter Degeneration in Cognitively Unimpaired Individuals

Retinal thickness changes in different subfields reflect the volume change of cerebral white matter hyperintensity

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