Besides cerebrovascular disease, medial temporal lobe atrophy (MTA), a neuroimaging finding suggestive of degenerative pathology, has been shown in vascular dementia (VaD). However, it is unknown to ...what extent MTA contributes to the pattern of cognitive impairment observed in VaD. Therefore, our purpose was to investigate the relative contribution of cerebrovascular disease and MTA to cognitive impairment in patients fulfilling diagnostic criteria for VaD.
We examined 590 patients (374 men; mean age, 73 years; standard deviation, 8) with probable VaD according to the National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria at inclusion into a multicenter clinical trial. Cerebrovascular disease and the degree of MTA were evaluated by using MRI. Cognitive testing included the Mini-Mental State Examination, and the vascular dementia assessment scale.
On the basis of the operational definitions for the neuroimaging part of the National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria, 485 (82.2%) patients had small vessel VaD and 153 (25.9%) had large vessel VaD. More than half (59.8%) of the patients had considerable MTA. Multiple linear regression analyses revealed that after correction for sex, age, education, and duration of dementia, neuropsychological tests showed that patients with higher grades of MTA or large vessel VaD had significantly worse general cognitive and executive functioning, whereas associations with small vessel disease were restricted to worse executive functioning.
Both MTA and large vessel disease contribute to global cognitive impairment in VaD. Small vessel disease contributes to executive dysfunction.
•Registration-based methods applied to serial high-resolution T1-weighted magnetic resonance imaging can be used to assess brain volume changes in patients with anorexia nervosa (AN).•Brain volume ...changes were found to be strongly associated with variations in the body mass index of patients with AN of the restricting type.•Therefore, assessments of brain volume change may become an additional measure of AN severity.
We aimed to determine whether variation in the body mass index (BMI)—a marker of anorexia nervosa (AN) severity—is associated with brain volume changes longitudinally estimated using registration-based methods on serial high-resolution T1-weighted magnetic resonance images (MRI). Fifteen female patients (mean age = 21 years; standard deviation SD = 5.7; range: 15–33 years) with the diagnosis of AN of the restricting type (AN-r)—according to the Diagnostic and Statistic Manual of Mental Disorders, 5th edition criteria—underwent T1-weighted MRI at baseline and after a mean follow-up period of 11 months (SD = 6.4). We used the brain boundary shift integral (BSI) and the ventricular BSI (VBSI) to estimate volume changes after registering voxels of follow-up onto baseline MRI. Very significant and strong correlations were found between BMI variation and the brain BSI, as well as between BMI variation and the VBSI. After adjustment for age at onset, duration of illness, and the BMI rate of change before baseline MRI, the statistical significance of both associations persisted. Registration-based methods on serial MRI represent an additional tool to estimate AN severity, because they provide measures of brain volume change strongly associated with BMI variation.
Intracranial arterial stenosis (IAS) is usually attributable to atherosclerosis and corresponds to the most common cause of stroke worldwide. It is very prevalent among African, Asian, and Hispanic ...populations. Advancing age, systolic hypertension, diabetes mellitus, high levels of low-density lipoprotein cholesterol, and metabolic syndrome are some of its major risk factors. IAS may be associated with transient or definite neurological symptoms or can be clinically asymptomatic. Transcranial Doppler and magnetic resonance angiography are the most frequently used ancillary examinations for screening and follow-up. Computed tomography angiography can either serve as a screening tool for the detection of IAS or increasingly as a confirmatory test approaching the diagnostic accuracy of catheter digital subtraction angiography, which is still considered the gold (confirmation) standard. The risk of stroke in patients with asymptomatic atherosclerotic IAS is low (up to 6% over a mean follow-up period of approximately 2 years), but the annual risk of stroke recurrence in the presence of a symptomatic stenosis may exceed 20% when the degree of luminal narrowing is 70% or more, recently after an ischemic event, and in women. It is a matter of controversy whether there is a specific type of treatment other than medical management (including aggressive control of vascular risk factors and antiplatelet therapy) that may alter the high risk of stroke recurrence among patients with symptomatic IAS. Endovascular treatment has been thought to be helpful in patients who fail to respond to medical treatment alone, but recent data contradict such expectation.
Abstract The diagnosis of Alzheimer disease (AD) at an early age of onset may be a challenging task. The diagnosis of such a type of dementia may be even more difficult when concomitant depressive ...symptoms occur. We report the case of a 51-year-old woman who was admitted at a Psychiatric Day Hospital presenting with depressive symptoms, visuospatial deficits, apraxia, and minor memory loss. The patient underwent long-term antidepressant therapy, but despite the improvement of depressive symptoms, there was progressive cognitive deterioration. Otherwise, the prior clinical history was unremarkable, and there was no family history of dementia. The clinical examination revealed cognitive deficits in several domains. The patient scored 12 in the Mini-Mental State Examination. Routine laboratory tests were normal. Magnetic resonance (MR) imaging showed global brain volume loss more pronounced than would be expected for someone of the patient's age, especially in the precuneus—a pattern of posterior cortical atrophy consistent with the diagnosis of early-onset AD. Images obtained with 99mTc-HMPAO single-photon emission computed tomography (SPECT) also revealed marked brain hypoperfusion involving the left parietal lobe, far beyond the regions of brain volume loss. This clinical case report illustrates the relative contribution of both MR imaging and SPECT for the diagnosis of dementia in a patient with concomitant depressive symptoms. Apart from contributing to the diagnosis of dementia beyond the traditional exclusionary approach, neuroimaging is increasingly being used to classify its particular subtypes. The role of neuroimaging role in AD is also supported by a recent proposal of revised diagnostic criteria, which take into account abnormal biomarkers of disease.
Infratentorial abnormalities in vascular dementia BASTOS LEITE, Antönio J; VAN DER FLIER, Wiesje M; VAN STRAATEN, Elisabeth C. W ...
Stroke (1970),
2006, 2006-Jan, 2006-01-00, 20060101, Letnik:
37, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Infratentorial abnormalities may cause cognitive deficits, but current research criteria for vascular dementia (VaD) do not consider them. Our purposes were to determine the prevalence of ...infratentorial abnormalities in VaD, their relation with supratentorial abnormalities, and whether they are relevant to cognition.
We examined 182 patients (120 men, mean age=73 years, SD=8) with probable VaD at inclusion into a multicenter clinical trial. MRI scans were evaluated for infratentorial vascular abnormalities, midbrain atrophy, cerebellar atrophy, basilar artery diameter and tortuosity, and supratentorial abnormalities. Cognitive testing included the mini-mental state examination (MMSE) and the vascular dementia assessment scale (VaDAS-cog).
One hundred forty-one (77.5%) patients had infratentorial abnormalities: 119 (65.4%) had focal infratentorial vascular lesions, 65 (35.7%) had diffuse pontine vascular abnormalities hyperintense on T2-weighted images, 20 (11.0%) had midbrain atrophy, and 16 (8.8%) had cerebellar atrophy. Significant correlations were found between number of infratentorial vascular lesions and basilar artery diameter (rs=0.26; P<0.0001), infratentorial and basal ganglia (including thalamus) vascular abnormalities (rs=0.30; P<0.0001), as well as between midbrain atrophy and global supratentorial atrophy (rs=0.27; P<0.0001). Infratentorial vascular abnormalities and cerebellar atrophy were not significantly associated with cognitive impairment. Patients with midbrain atrophy performed worse on cognitive tests than those without midbrain atrophy. After correction for sex, age, education, supratentorial abnormalities, and center, midbrain atrophy remained significantly associated with lower MMSE scores (P<0.05).
Infratentorial abnormalities often occur in patients with VaD, but only midbrain atrophy was found to be relevant to cognition.
The number of elderly people is increasing rapidly and, therefore, an increase in neurodegenerative and cerebrovascular disorders causing dementia is expected. Alzheimer disease (AD) is the most ...common cause of dementia. Vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are the most frequent causes after AD, but a large proportion of patients have a combination of degenerative and vascular brain pathology. Characteristic magnetic resonance (MR) imaging findings can contribute to the identification of different diseases causing dementia. The MR imaging protocol should include axial T2-weighted images (T2-WI), axial fluid-attenuated inversion recovery (FLAIR) or proton density-weighted images, and axial gradient-echo T2*-weighted images, for the detection of cerebrovascular pathology. Structural neuroimaging in dementia is focused on detection of brain atrophy, especially in the medial temporal lobe, for which coronal high resolution T1-weighted images perpendicular to the long axis of the temporal lobe are extremely important. Single photon emission computed tomography and positron emission tomography may have added value in the diagnosis of dementia and may become more important in the future, due to the development of radioligands for in vivo detection of AD pathology. New functional MR techniques and serial volumetric imaging studies to identify subtle brain abnormalities may also provide surrogate markers for pathologic processes that occur in diseases causing dementia and, in conjunction with clinical evaluation, may enable a more rigorous and early diagnosis, approaching the accuracy of neuropathology.
Abstract Multiple sclerosis (MS) is primarily a white matter disease, but may also involve the gray matter, a feature not often demonstrated in vivo. This report presents the case of a patient with ...MS and clinical features mimicking frontotemporal dementia due to clear-cut cortical gray matter involvement in the left frontal lobe.
The criteria of the National Institute of Neurological Disorders and Stroke (NINDS)-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) include thalamic lesions ...for the diagnosis of vascular dementia (VaD). Although studies concerning VaD and brain aging advocate the use of fluid-attenuated inversion recovery (FLAIR) or T2-weighted images (T2-WI) to detect ischemic lesions, none compared the sensitivity of these sequences to depict thalamic lesions.
We performed a blinded review of T2-WI and FLAIR images in 73 patients fulfilling the radiological part of the NINDS-AIREN criteria (mean age, 71 years; range, 49 to 83 years). This sample was drawn from a large multicenter trial on VaD and was expected to have a high prevalence of thalamic lesions. In a side-by-side review, including T1-weighted images as well, lesions were classified according to presumed underlying pathology.
The total number of thalamic lesions was 214. Two hundred eight (97%) were detected on T2-WI, but only 117 (55%) were detected on FLAIR (chi(2)=5.1; P<0.05). Although the mean size of lesions detected on T2-WI and not on FLAIR (4.4 mm) was significantly lower than the mean size of lesions detected on both sequences (6.7 mm) (P<0.001), 5 of the 29 lesions >10 mm on T2-WI were not visible on FLAIR. FLAIR detected only 81 (51%) of the 158 probable ischemic lesions and 30 (60%) of the 50 probable microbleeds.
FLAIR should not be used as the only T2-weighted sequence to detect thalamic lesions in patients suspected of having VaD.
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