Cerebral Microbleeds and Cognition

Hilal, Saima; Saini, Monica; Tan, Chuen Seng; Catindig, Joseree Ann; Koay, Way Inn; Niessen, Wiro J.; Vrooman, Henri A.; Wong, Tien Yin; Chen, Christopher; Ikram, M. Kamran; Venketasubramanian, Narayanaswamy

doi:10.1097/wad.0000000000000015

Cited by 54 publications

(20 citation statements)

References 21 publications

(24 reference statements)

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“…Hence, the relative influences of CeVD markers need to be considered. Notably, the independent effect of microbleeds with impairment on visuoconstruction, executive function, visuomotor speed, and language domains is in line with several population-based studies 34,40,41 and suggests that microbleeds also exacerbate the progression of certain cognitive deficits. Both microbleeds and WMH are linked to cerebral amyloid angiopathy 42,43 and the deposition of β-amyloid in cerebral vessel walls.…”

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confidence: 57%

Association of Magnetic Resonance Imaging Markers of Cerebrovascular Disease Burden and Cognition

Hilal

Collinson

et al. 2015

Stroke

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Background and Purpose-The present study sought to examine the association between the burden of cerebrovascular disease (CeVD) as assessed by multimodal magnetic resonance imaging and neurocognitive function. Methods-Cognitively impaired patients and controls were tested on an extensive neuropsychological battery and underwent multimodal brain magnetic resonance imaging. CeVD markers determined from magnetic resonance imaging included the presence of multiple lacunes, multiple cerebral microbleeds, and moderate or severe white matter hyperintensities as markers for small-vessel disease and cortical stroke and intracranial stenosis as markers for large-vessel disease. A weighted CeVD burden score was constructed, and its association with global and domain-specific cognitive performance was investigated. Results-A total of 305 cases and 94 controls were included in the analysis. A graded association of CeVD burden with neurocognitive function was found. Moreover, a clear threshold of CeVD burden was associated with severe impairment. White matter hyperintensities was associated with global neurocognitive deficits, whereas microbleeds were associated with domain-specific impairments. Conclusions-The weighted CeVD burden score comprising markers of both small-and large-vessel diseases were associated with deficits in both global and domain-specific neurocognitive function. Additional studies are needed to validate the use of this CeVD burden score for the prediction of dementia.

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Section: Figuresupporting

confidence: 57%

Association of Magnetic Resonance Imaging Markers of Cerebrovascular Disease Burden and Cognition

Hilal

Collinson

et al. 2015

Stroke

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“…MRI is the imaging modality of choice to detect hemorrhagic and non-hemorrhagic DAI, because CT exams are often false negative towards DAI [ 12 ]. Currently T2*w GRE sequences and increasingly SWI are used for the detection of cerebral microbleeds as radiological hallmark of DAI [ 10 , 14 , 18 , 25 ]. Non-hemorrhagic DAI, based on a widespread disruption of axons, can be diagnosed with diffusion tensor imaging (DTI), diffusion weighted imaging (DWI), MR spectroscopy, and conventional MR sequences [ 24 , 26 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Diffuse Axonal Injury at Ultra-High Field MRI

et al. 2015

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ObjectiveDiffuse axonal injury (DAI) is a specific type of traumatic brain injury caused by shearing forces leading to widespread tearing of axons and small vessels. Traumatic microbleeds (TMBs) are regarded as a radiological marker for DAI. This study aims to compare DAI-associated TMBs at 3 Tesla (T) and 7 T susceptibility weighted imaging (SWI) to evaluate possible diagnostic benefits of ultra-high field (UHF) MRI.Material and Methods10 study participants (4 male, 6 female, age range 20-74 years) with known DAI were included. All MR exams were performed with a 3 T MR system (Magnetom Skyra) and a 7 T MR research system (Magnetom 7 T, Siemens AG, Healthcare Sector, Erlangen, Germany) each in combination with a 32-channel-receive coil. The average time interval between trauma and imaging was 22 months. Location and count of TMBs were independently evaluated by two neuroradiologists on 3 T and 7 T SWI images with similar and additionally increased spatial resolution at 7 T. Inter- and intraobserver reliability was assessed using the interclass correlation coefficient (ICC). Count and diameter of TMB were evaluated with Wilcoxon signed rank test.ResultsSusceptibility weighted imaging revealed a total of 485 TMBs (range 1-190, median 25) at 3 T, 584 TMBs (plus 20%, range 1-262, median 30.5) at 7 T with similar spatial resolution, and 684 TMBs (plus 41%, range 1-288, median 39.5) at 7 T with 10-times higher spatial resolution. Hemorrhagic DAI appeared significantly larger at 7 T compared to 3 T (p = 0.005). Inter- and intraobserver correlation regarding the counted TMB was high and almost equal 3 T and 7 T.Conclusion7 T SWI improves the depiction of small hemorrhagic DAI compared to 3 T and may be supplementary to lower field strengths for diagnostic in inconclusive or medicolegal cases.

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“…Our findings are in line with the result of the Epidemiology of Dementia in Singapore Study. 25 They found that CMBs were associated with deficits in executive functions, but that only the deficits in the visuoconstruction domain reached a robust statistical significance. Visuospatial and verbal executive functions involve different neural networks.…”

Section: Discussionmentioning

confidence: 99%

Strictly Lobar Cerebral Microbleeds Are Associated With Cognitive Impairment

Chung

Chou

Chen

et al. 2016

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2 In addition to being an age-related cerebrovascular abnormality, [3][4][5] CMBs are associated with dementia. The prevalence of CMBs is reported to be higher in patients with Alzheimer's disease (AD) and vascular dementia compared with the general population. 6 The mechanisms underlying CMBs and their effects on neuropsychological functions are subjects of active research.CMB in different locations might be related to different clinical manifestations. 3,7,8 The incidence of both CMB types increases with age. However, deep or infratentorial (DI) and strictly lobar (SL) CMBs have different risk factors. DI and SL CMBs are correlated with hypertension and APOE ɛ4 genotype, respectively. Therefore, DIs are usually attributed to hypertension vasculopathy, and SL CMBs are attributed to cerebral amyloid angiopathy (CAA). 3,7,8 The effects of CMBs on cognitive function in the general population have been evaluated in previous studies. However, there are inconsistent results regarding the location of CMBs that are associated with cognitive loss. In addition, only a few Asian CMB studies have evaluated the effects of CMBs on different cognitive domains. Therefore, the present study aimed to study the possible Background and Purpose-Different distributions of cerebral microbleeds (CMBs) are associated with distinct pathological mechanisms. Lobar CMBs are thought to be related to cerebral amyloid angiopathy, whereas deep or infratentorial CMBs are related to hypertensive vasculopathy. The present study aimed to evaluate the effects of CMBs and their locations on a variety of cognitive domains. Methods-Study subjects were selected from the community-based I-Lan Longitudinal Aging Study. We assessed cognitive domains, including verbal memory, language, visuospatial executive function, and verbal executive function. CMBs were evaluated using 3T susceptibility-weighted magnetic resonance imaging. Results-We studied 959 subjects (mean±SD, 62.5±8.6 years; 425 [44.3%] men). CMBs were found in 14.2% of the population. We classified subjects with CMBs into 2 different groups based on the locations of their CMBs: (1) deep or infratentorial (85 subjects, 8.8% of population) and (2) strictly lobar (49, 5.1%). Multivariate linear analysis showed that strictly lobar CMBs were significantly associated with deficits in global cognitive function (Mini-Mental State Examination) and visuospatial executive function, as determined by the copy test of the Taylor complex figure test and the clock drawing test. We adjusted our results for age, sex, years of education, cardiovascular risk factors, and other markers of cerebral small vessel disease, lacunes, and white matter hyperintensity. Deep or infratentorial CMBs were not associated with changes in cognitive function in our population. Conclusions-Strictly lobar, but not deep or infratentorial, CMBs are associated with changes in cognitive function, especially in visuospatial executive functions. Cerebral amyloid angiopathy may be the underlying pathology associated with CMB-related cognitiv...

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Cerebral Microbleeds and Cognition

Cited by 54 publications

References 21 publications

Association of Magnetic Resonance Imaging Markers of Cerebrovascular Disease Burden and Cognition

Association of Magnetic Resonance Imaging Markers of Cerebrovascular Disease Burden and Cognition

Diffuse Axonal Injury at Ultra-High Field MRI

Strictly Lobar Cerebral Microbleeds Are Associated With Cognitive Impairment

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