Total Cerebral Blood Flow, White Matter Lesions and Brain Atrophy: The SMART-MR Study

Appelman, Auke P.A.; Graaf, Yolanda van der; Vincken, Koen L.; Tiehuis, A.M.; Witkamp, Theo D.; Mali, Willem P.Th.M.; Geerlings, Mirjam I.

doi:10.1038/sj.jcbfm.9600563

Cited by 81 publications

(85 citation statements)

References 38 publications

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“…34 In patients who suffer from arterial disease, a lower CBF was found to be associated with ventricular enlargement (a proxy for brain atrophy) but only in the presence of moderate-to-severe WML volume. 35 In general, previous studies interpreted their data largely as that a lower CBF precedes brain atrophy. Interestingly, our data suggest the opposite: a smaller brain volume at baseline precedes a decrease in CBF.…”

Section: Discussionmentioning

confidence: 99%

The Bidirectional Association between Reduced Cerebral Blood Flow and Brain Atrophy in the General Population

Zonneveld

Loehrer

Hofman

et al. 2015

J Cereb Blood Flow Metab

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The question remains whether reduced cerebral blood flow (CBF) leads to brain atrophy or vice versa. We studied the longitudinal relation between CBF and brain volume in a community-dwelling population. In the Rotterdam Study, 3011 participants (mean age 59.6 years (s.d. 8.0)) underwent repeat brain magnetic resonance imaging to quantify brain volume and CBF at two time points. Adjusted linear regression models were used to investigate the bidirectional relation between CBF and brain volume. We found that smaller brain volume at baseline was associated with a steeper decrease in CBF in the whole population (standardized change per s.d. increase of total brain volume (TBV) = 0.296 (95% confidence interval (CI) 0.200; 0.393)). Only in persons aged ⩾ 65 years, a lower CBF at baseline was associated with steeper decline of TBV (standardized change per s.d. increase of CBF = 0.003 (95% CI − 0.004; 0.010) in the whole population and 0.020 (95% CI 0.004; 0.036) in those aged ⩾ 65 years of age). Our results indicate that brain atrophy causes CBF to decrease over time, rather than vice versa. Only in persons aged 465 years of age did we find lower CBF to also relate to brain atrophy.

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Section: Discussionmentioning

confidence: 99%

The Bidirectional Association between Reduced Cerebral Blood Flow and Brain Atrophy in the General Population

Zonneveld

Loehrer

Hofman

et al. 2015

J Cereb Blood Flow Metab

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“…In experiments using a rat model, artificially imposed cerebral hypoperfusion resulted in elevated levels of white matter damage 30 -an observation consistent with clinical associations of white matter hyperintensities and low CBF. 31 Hypoperfusion is likely to be particularly damaging to sub-cortical, watershed regions of the brain in which capillary density is sparse and blood flow is low under normal conditions. 32 The observation by Lipsitz et al…”

Section: Discussionmentioning

confidence: 99%

Association between arterial stiffness and cerebrovascular resistance in the elderly

2009

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Arterial stiffness is an established cardiovascular risk factor influencing haemodynamic properties in the microcirculation. We tested the hypothesis that increased arterial stiffness is associated with an increase in cerebrovascular resistance in the elderly. Brachialankle pulse wave velocity (baPWV), using arterial tonometry, and anterior cerebral blood flow (aCBF), using extracranial ultrasound, were measured in 26 participants (67-92 years). Non-parametric statistics examined relationships between age, blood pressure, baPWV, cerebrovascular resistance (CVRi) and aCBF. Bivariate analysis suggested that baPWV was the only vascular characteristic associated with CVRi (r s ¼ 0.59; P ¼ 0.002). CVRi was strongly correlated with aCBF (r s ¼ À0.89; Po0.001). Furthermore, compared with participants in the lower three quartiles of baPWV (LO) ; P ¼ 0.09). This study found a positive correlation between baPWV and CVRi in the elderly, suggesting that haemodynamic characteristics associated with arterial aging influence cerebral circulation.

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“…This protocol has been described elsewhere. 29 At baseline and follow-up, the MRI was performed on a 1.5T wholebody system (Gyroscan ACS-NT, Philips Medical Systems, Best, the Netherlands). The protocol consisted of transversal T1-weighted (repetition time …”

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confidence: 99%

Arterial stiffness and progression of structural brain changes

Jochemsen¹,

Muller²,

Bots³

et al. 2015

Neurology

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Objective: To examine the cross-sectional and prospective associations between arterial stiffness and structural brain changes within the Second Manifestations of Arterial Disease-Magnetic Resonance (SMART-MR) study, a prospective cohort study among patients with manifest arterial disease.Methods: Distension measurements of the common carotid arteries and a brain MRI were performed in 526 patients (mean age 59 6 10 years). After a mean follow-up of 4.1 years (range 3.6-5.8), brain MRI was repeated in 308 patients. Brain segmentation was used to quantify total brain volume, cortical gray matter volume, ventricular volume, and white matter lesion (WML) volume (relative to intracranial volume). Infarcts were rated visually.Results: Cross-sectional multivariable regression analyses showed that 1 SD decrease in carotid distension, indicating increased arterial stiffness, was associated with smaller relative total brain and cortical gray matter volumes (B 5 20.24%, 95% confidence interval [CI] 20.44 to 20.04%, and B 5 20.47%, 95% CI 20.75 to 20.19%), with larger WML volume (B 5 0.09%, 95% CI 20.01 to 0.19%), and with higher risk of having nonlacunar (cortical or large subcortical) brain infarcts (relative risk 5 1.44, 95% CI 1.14 to 1.81). However, our prospective findings showed that carotid distension was not significantly associated with progression of brain atrophy, WML volume, or brain infarcts. Conclusion:In this population of patients with manifest arterial disease, stiffening of the carotid arteries was cross-sectionally associated with more brain atrophy, WML volume, and nonlacunar infarcts, but did not lead to changes in brain volumes or infarcts after 4 years. Neurology ® 2015;84:448-455 GLOSSARY ACE 5 angiotensin-converting enzyme; ANCOVA 5 analysis of covariance; BA 5 basilar artery; BMI 5 body mass index; BP 5 blood pressure; CC 5 compliance coefficient; CI 5 confidence interval; CIMT 5 carotid intima media thickness; DC 5 distensibility coefficient; FLAIR 5 fluid-attenuated inversion recovery; ICA 5 internal carotid artery; ICV 5 intracranial volume; IR 5 inversion recovery; OR 5 odds ratio; pCBF 5 parenchymal cerebral blood flow; RR 5 relative risk; SMART-MR 5 Second Manifestations of Arterial Disease-Magnetic Resonance; TE 5 echo time; TI 5 inversion time; TR 5 repetition time; WML 5 white matter lesion; YEM 5 Young's elastic modulus.One of the hallmarks of the aging cardiovascular system is stiffening of the arterial wall. Arterial stiffness is related to age and cardiovascular risk factors, especially elevated blood pressure, smoking, obesity, and diabetes mellitus.1 It can therefore be seen as a summary measure of vascular risk. Yet it also is an independent risk factor for myocardial infarction, cardiovascular death, and clinical stroke. 2-5It has been well established that cardiovascular risk factors play an important role in the development of cognitive decline and dementia.6 Arterial stiffness may be among these factors. 7-10

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Total Cerebral Blood Flow, White Matter Lesions and Brain Atrophy: The SMART-MR Study

Cited by 81 publications

References 38 publications

The Bidirectional Association between Reduced Cerebral Blood Flow and Brain Atrophy in the General Population

The Bidirectional Association between Reduced Cerebral Blood Flow and Brain Atrophy in the General Population

Association between arterial stiffness and cerebrovascular resistance in the elderly

Arterial stiffness and progression of structural brain changes

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