Relationship Between Cerebral Vasomotor Reactivity and White Matter Lesions in Elderly Subjects Without Large Artery Occlusive Disease

Fu, Jian Hui; Lu, Chuan Zhen; Hong, Zhen; Dong, Qiang; Ding, Ding; Wong, Ka Sing

doi:10.1111/j.1552-6569.2006.00030.x

Cited by 38 publications

(31 citation statements)

References 30 publications

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“…Further, decreased cVMR is related to cognitive impairment, 33 and dysfunction of cerebral vascular autoregulation contributes to the pathogenesis of white matter lesions in advancing age. 34 Cerebral white matter lesions are an early marker of cerebrovascular disease and are considered a risk factor for the development of stroke 35 and cognitive impairment. 36,37 Finally, depressive symptoms, which are highly prevalent after stroke, are linked to reduced blood flow velocities and lower vasomotor reactivity.…”

Section: Discussionmentioning

confidence: 99%

Improved Cerebral Vasomotor Reactivity After Exercise Training in Hemiparetic Stroke Survivors

Ivey

Ryan

Hafer‐Macko

et al. 2011

Stroke

115

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Background and Purpose-Animal studies provide strong evidence that aerobic exercise training positively influences cerebral blood flow, but no human studies support the use of exercise for improving cerebral hemodynamics. This randomized study in stroke survivors assessed the effects of treadmill aerobic exercise training (TM) on cerebral blood flow parameters compared to a control intervention of nonaerobic stretching. Methods-Thirty-eight participants (19 in TM group and 19 in control group) with remote stroke (Ͼ6 months) and mild to moderate gait deficits completed middle cerebral artery blood flow velocity measurements by transcranial Doppler ultrasonography before and after a 6-month intervention period. Middle cerebral artery blood flow velocity was assessed bilaterally during normocapnia and hypercapnia (6% CO 2 ). Cerebral vasomotor reactivity (cVMR) was calculated as percent change in middle cerebral artery blood flow velocity from normocapnia to hypercapnia (cVMR percent) and as an index correcting percent change for absolute increase in end tidal CO 2 (cVMR index). Results-The TM group had significantly larger improvements than did controls for both ipsilesional and contralesional cVMR index (PՅ0.05) and contralesional cVMR percent (PՅ0.01). Statin users in the TM group (nϭ10) had higher baseline cVMR and lower training-induced cVMR change, indicating that cVMR change among those not using statins (nϭ9) primarily accounted for the between-group effects. There was a 19% increase in VO 2 peak for the TM group compared to a 4% decrease in the control group (PϽ0.01), and peak fitness change correlated with cVMR change (rϭ0.55; PϽ0.05). Conclusions-Our data provide the first evidence to our knowledge of exercise-induced cVMR improvements in stroke survivors, implying a protective mechanism against recurrent stroke and other brain-related disorders. Statin use appears to regulate cVMR and the cVMR training response. (Stroke.

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Section: Discussionmentioning

confidence: 99%

Improved Cerebral Vasomotor Reactivity After Exercise Training in Hemiparetic Stroke Survivors

Ivey

Ryan

Hafer‐Macko

et al. 2011

Stroke

115

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“…Secondly, multiple LAA increases the quantity of arterial thromboemboli at the narrowing site and impairs the washout and clearance of emboli because of the reduced blood flow and decreased perfusion after arterial stenosis [20]. Finally, severe WML has been recognized to result, at least in part, from repeated ischemic insults because of damaged cerebral blood flow autoregulation, a consequence of arteriolosclerosis due to stroke risk factors [21]. Coexistence of WML in patients with multiple LAA may deteriorate hypoperfusion in anatomical white matter watershed areas where there is rarely collateral compensation and result in the occurrence of ischemic events.…”

Section: Discussionmentioning

confidence: 99%

Coexisting Small Vessel Disease Predicts Poor Long-Term Outcome in Stroke Patients with Intracranial Large Artery Atherosclerosis

Chen

et al. 2010

Cerebrovasc Dis

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Background and Purposes: Until now, limited data are available about the potential effect of coexisting small vessel disease (SVD) on the long-term outcome of stroke patients with intracranial large artery atherosclerosis (ILAA). Methods: A prospective study was performed on 293 patients with symptomatic ILAA, who were divided into 4 groups (group I, single intracranial large artery atherosclerosis (SILAA) without SVD; group II, multiple intracranial large arteries atherosclerosis (MILAA) without SVD; group III, SILAA with SVD; group IV, MILAA with SVD) and followed up for recurrent stroke or death. Results: The 3-year cumulative risks of recurrent stroke were 18% for SILAA without SVD, 38% for MILAA without SVD, 21% for SILAA with SVD and 34% for MILAA with SVD. The 3-year cumulative risks of death were 6, 7, 20 and 22%, respectively. Compared with SILAA without SVD, more recurrent stroke occurred in MILAA without SVD (log-rank 3.83; p = 0.050) and MILAA with SVD (log-rank 7.79; p = 0.014), and the higher risk of death (log-rank 9.472; p = 0.002) was found in group MILAA with SVD. A Cox proportional-hazards regression model showed that MILAA with SVD may be a predictor of recurrent stroke (hazard ratio 2.001; 95% CI 1.108–3.934; p = 0.044), and a borderline predictor for death (hazard ratio 3.180; 95% CI 0.895–10.987; p = 0.073). Conclusion: Coexisting SVD is very common and may predict poor outcome in stroke patients with symptomatic ILAA.

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“…Evidence suggests that the presence of symptomatic cardiovascular disease, including myocardial infarction and stroke as well as peripheral artery disease, is associated with cognitive impairment in elderly people [2][3][4] . However, many individuals with significant atherosclerotic disease remain asymptomatic in terms of coronary or cerebrovascular events [5] . The relationship between markers of generalized atherosclerosis, including subclinical disease, and cognitive impairment in old age is controversial.…”

Section: Introductionmentioning

confidence: 99%

Cardio-Ankle Vascular Index as a Predictor of Cognitive Impairment in Community-Dwelling Elderly People: Four-Year Follow-Up

Yamamoto¹,

Yamanaka²,

Ishikawa³

et al. 2009

Dement Geriatr Cogn Disord

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Background/Aim: The relation between markers of generalized atherosclerosis and cognitive impairment in old age is controversial. The aim of the study was to evaluate the cardio-ankle vascular index (CAVI) as a predictor of longitudinal changes in cognitive function in older individuals. Methods: We evaluated the cognitive function in elderly people with high (AS(+)) and low (AS(–)) values of CAVI each year over 4 years. Results: The changes in the Hasegawa Dementia Scale Revised (HDS-R) and the mini-mental state examination (MMSE) at 4 years were significantly larger in the AS(+) group (AS(+) vs. AS(–) = –1.8 ± 4.4 vs. 0.3 ± 2.8 points and –1.1 ± 3.0 vs. 0.1 ± 2.3 points, p = 0.008 and 0.03, respectively). The annual changes in the HDS-R were significantly decreased from baseline at 1 year later to 4 years later in AS(+) (baseline vs. 1, 2, 3, 4 years = 26.5 vs. 25.0, 25.5, 25.7, 24.8 points, p < 0.001); in comparison, the annual changes in MMSE significantly decreased from the baseline over the 4 years in AS (+) (baseline vs. 1, 2, 3, 4 years = 26.8 vs. 26.2, 25.8, 26.4, 25.7 points, p = 0.002). Conclusion: The results of this study suggest that elderly people with a high CAVI value are at a greater risk of cognitive decline.

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Relationship Between Cerebral Vasomotor Reactivity and White Matter Lesions in Elderly Subjects Without Large Artery Occlusive Disease

Cited by 38 publications

References 30 publications

Improved Cerebral Vasomotor Reactivity After Exercise Training in Hemiparetic Stroke Survivors

Improved Cerebral Vasomotor Reactivity After Exercise Training in Hemiparetic Stroke Survivors

Coexisting Small Vessel Disease Predicts Poor Long-Term Outcome in Stroke Patients with Intracranial Large Artery Atherosclerosis

Cardio-Ankle Vascular Index as a Predictor of Cognitive Impairment in Community-Dwelling Elderly People: Four-Year Follow-Up

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