Neuropsychological Impairment Correlates With Hypoperfusion and Hypometabolism but Not With Severity of White Matter Lesions on MRI in Patients With Cerebral Microangiopathy

Sabri, Osama; Ringelstein, E. Bernd; Hellwig, Dirk; Schneider, R; Schreckenberger, Mathias; Kaiser, H.; Mull, Michael; Buell, Udalrich

doi:10.1161/01.str.30.3.556

Cited by 165 publications

(136 citation statements)

References 47 publications

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“…The mild SIVaD group showed a significant reduction in bilateral insula, anterior and posterior cingulate gyrus, precentral gyrus, and subcallosal gyrus and right inferior parietal lobule. This is consistent with the predilection of ischemic lesions, which affect the prefrontal subcortical circuit in VaD, and corresponds to the decreased rCP in the frontal, temporal and parietal lobes, which was previously reported to be observed irrespective of neuropsychological deficit [22].…”

Section: Discussionsupporting

confidence: 91%

Analysis of Cerebral Blood Flow with Single Photon Emission Computed Tomography in Mild Subcortical Ischemic Vascular Dementia

Park

Yoon

Lee

et al. 2014

Nucl Med Mol Imaging

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Purpose The mechanism of cognitive dysfunction of subcortical ischemic vascular dementia (SIVaD) is not yet fully understood. The objective of this study was to investigate and compare the distribution of regional cerebral perfusion (CP) change in the mild forms of SIVaD, a relatively homogeneous subtype of vascular dementia, using statistical parametric mapping (SPM) analysis of the technetium-99m hexamethylproplyeneamineoxime (Tc-99m HMPAO) single photon emission computed tomography (SPECT). Materials and Methods A total of 28 patients with mild SIVaD and 33 healthy controls were prospectively recruited and underwent SPECT imaging studies between January 2012 and May 2013. SPECT was performed to measure the regional CP, and SPM was applied to the analysis of the SPECT data. Results The regional CP was significantly decreased in the bilateral insula, anterior and posterior cingulated gyrus, precentral gyrus, and subcallosal gyrus as well as the right inferior parietal lobule in the SIVaD patients compared to the controls (corrected p=0.01). The pattern of CP abnormality correlated well with those previously reported in later forms of SIVaD. Conclusions Reduction of CP in the brain areas mentioned was present earlier on in the natural course of SIVaD pathophysiology. Our study suggests that cognitive dysfunction of SIVaD may be related to these regional CP deficits.

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Section: Discussionsupporting

confidence: 91%

Analysis of Cerebral Blood Flow with Single Photon Emission Computed Tomography in Mild Subcortical Ischemic Vascular Dementia

Park

Yoon

Lee

et al. 2014

Nucl Med Mol Imaging

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“…(48). Although these observations have not been consistently replicated (49,50), it is reasonable to assume that both the location and the volume of WMLs may influence their effect on regional cortical metabolism and function. (24) It is not clear yet whether the association of WMLs with cortical atrophy and hypometabolism is due to Wallerian degeneration or due to retrograde degeneration and deafferentiation.…”

Section: Histopathologic Correlatesmentioning

confidence: 99%

“…The method allows assessment of the regional cerebral blood flow and volume. Investigators have found that there is a gradation of flow and blood volume in WMLs that decreases from normal tissue on the periphery to reduced values in the center of a lesion (49).…”

Section: Image Acquisitionmentioning

confidence: 99%

Classification of White Matter Lesions on Magnetic Resonance Imaging in Elderly Persons

Kim

MacFall

Payne

2008

Biological Psychiatry

433

415

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White matter lesions, commonly seen on magnetic resonance images of elderly people, are related to various geriatric disorders including cerebrovascular diseases, cardiovascular diseases, dementia, and psychiatric disorders. Currently, white matter lesions are divided into periventricular white matter lesions and deep white matter lesions. Although the meaning of these terms vary by study and this dichotomization itself is still in debate, a possible dissimilarity in pathogenic mechanisms between periventricular white matter lesions and deep white matter lesions are providing some clues for understanding pathophysiology of many geriatric syndromes associated with white matter lesions.We have reviewed the distinctions between periventricular white matter lesions and deep white matter lesions in terms of etiology, histopathology, functional correlates, and imaging methodologies. We suggest a new sub-classification of white matter lesions which may have better etiological and functional relevance than the current simple dichotomization. The new categories are juxtaventricular, periventricular, deep white, and juxtacortical. This new classification scheme may contribute to reducing the heterogeneity of white matter lesion findings in future research.

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“…These results are in agreement with Hund-Georgiadis et al (2002), who reported that morphological changes were not related to neuropsychological impairment in CMA. Further, Sabri et al (1998Sabri et al ( , 1999 showed that, in CMA, neuropsychological deficits correlate with functional imaging parameters such as regional cerebral blood flow and glucose utilization during rest, but not with lacunar infarctions and deep white matter lesions. One may conclude that the latter ones are epiphenomena that may morphologically characterize CMA but do not themselves indicate cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Slow Hemodynamic Oscillations are Impaired in Cerebral Microangiopathy

Schroeter

Bücheler

Preul

et al. 2005

J Cereb Blood Flow Metab

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Small-vessel disease or cerebral microangiopathy (CMA) is a common finding in elderly people. It is related to a variety of vascular risk factors and may finally lead to subcortical ischemic vascular dementia. Because vessel stiffness is increased, we hypothesized that slow spontaneous oscillations are reduced in cerebral hemodynamics. Accordingly, we examined spontaneous oscillations in the visual cortex of 13 patients suffering from CMA, and compared them with 14 agematched controls. As an imaging method we applied functional near-infrared spectroscopy, because it is particularly sensitive to the microvasculature. Spontaneous low-frequency oscillations (LFOs) (0.07 to 0.12 Hz) were specifically impaired in CMA in contrast to spontaneous very-lowfrequency oscillations (0.01 to 0.05 Hz), which remained unaltered. Vascular reagibility was reduced during visual stimulation. Interestingly, changes were tightly related to neuropsychological deficits, namely executive dysfunction. Vascular alterations had to be attributed mainly to the vascular risk factor arterial hypertension. Further, results suggest that the impairments might be, at least partly, reversed by medical treatment such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Results indicate that functional near-infrared spectroscopy may detect changes in the microvasculature due to CMA, namely an impairment of spontaneous LFOs, and of vascular reagibility. Hence, CMA accelerates microvascular changes due to aging, leading to impairments of autoregulation.

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Neuropsychological Impairment Correlates With Hypoperfusion and Hypometabolism but Not With Severity of White Matter Lesions on MRI in Patients With Cerebral Microangiopathy

Cited by 165 publications

References 47 publications

Analysis of Cerebral Blood Flow with Single Photon Emission Computed Tomography in Mild Subcortical Ischemic Vascular Dementia

Analysis of Cerebral Blood Flow with Single Photon Emission Computed Tomography in Mild Subcortical Ischemic Vascular Dementia

Classification of White Matter Lesions on Magnetic Resonance Imaging in Elderly Persons

Spontaneous Slow Hemodynamic Oscillations are Impaired in Cerebral Microangiopathy

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