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Dementia is a syndrome mainly characterized by acquired cognitive impairment, which is mainly manifested by the decrease of cognitive functions such as understanding, orientation, and visuospatial ability. Due to different intervention methods for different types of dementia, differential diagnosis is extremely important. Positron emission tomography (PET) can reflect the changes of brain function from multiple angles through different tracers, providing imaging basis for the differential diagnosis of dementia. This article reviews the characteristics of PET in patients with different types of dementia in order to provide ideas for the differential diagnosis of patients with different types of dementia.
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Post-stroke fatigue is one of the common symptoms of stroke patients. Continuous fatigue will affect the rehabilitation of patients' limb functions, lead to the decline of daily living ability, and at the same time, make patients lack energy, lose the initiative of rehabilitation exercise, and seriously affect the quality of life and social function. This article reviews the epidemiology, clinical characteristics, evaluation scales, influencing factors, pathophysiological mechanism and treatment of post-stroke fatigue.
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As a multifunctional signal molecule, fibroblast growth factor 21 (FGF21) has been proved to have a variety of biological effects, including anti-inflammatory, antioxidant stress, and neuroprotection. This article reviews the latest research progress on the protective effect of FGF21 in ischemic stroke and its relationship with cognitive impairment.
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Atherosclerosis (AS) is one of the pathological bases of ischemic stroke. AS caused by elevated low-density lipoprotein cholesterol levels is the main causative factor. However, recent studies have found that the traditional blood lipid indicators can not fully reflect the risk of stroke in high-risk populations. Non-traditional blood lipid parameters are developed from traditional blood lipid parameters, including remnant cholesterol (RC), non-high density lipoprotein cholesterol and a variety of blood lipid ratios, which may play a role in the prevention and treatment of cerebrovascular diseases. Among them, RC is increasingly recognized as a biomarker driving the residual risk of AS. It has been confirmed that RC is closely associated with the risk of cerebrovascular disease in the primary and secondary prevention studies of stroke.
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Vascular cognitive impairment (VCI) is a syndrome from mild cognitive impairment to dementia caused by various vascular risk factors and cerebrovascular diseases. Early detection and definite diagnosis can significantly improve the outcomes of patients with VCI. This article reviews the evaluation and diagnosis of VCI.
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Post-stroke depression (PSD) will seriously affect the recovery and outcome of patients with stroke. Diffusion tensor imaging (DTI) can not only show the course and integrity of nerve fiber bundles, but also quantitatively show the changes of white matter in the brain. Studies have shown that the occurrence of PSD is associated with white matter lesions and stroke sites, but the specific sites involved are still controversial. This article reviews the application of DTI in patients with PSD.
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Atrial fibrillation is one of the most common arrhythmia types. With the increase of age, atrial fibrillation will increase the incidence of silent cerebral infarction (SCI), and the correlation between them will lead to the aggravation of cognitive impairment. Atrial fibrillation can be regarded as an independent risk factor for accelerating cognitive impairment in patients with SCI, but the possible mechanism is not completely clear. Therefore, patients with atrial fibrillation should undergo MRI examination, find SCI in time and develop corresponding intervention measures in order to reduce or delay a series of subsequent negative effects. This article reviews the related cognitive impairment of SCI patients with atrial fibrillation.
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Objective:To investigate the correlation between total MRI burden and serum uric acid level in patients with cerebral small vessel disease(CSVD) and its gender differences.Methods:A total of 217 patients with CSVD were retrospectively included as the research objects, and the clinical data such as serum uric acid value were collected.The imaging findings of patients with CSVD were evaluated by MRI, and the total MRI burden score of CSVD was calculated.According to the total MRI burden score of CSVD, patients with CSVD were divided into mild-to-moderate burden group ( n=133) and severe burden group ( n=84). SPSS 20.0 software was used for data analysis and processing.Logistic regression was used to analyze the relationship between uric acid and the total MRI burden score of CSVD. Results:The serum uric acid of severe burden group was higher than that of mild-to-moderate burden group((326.94±70.95)μmol/L, (293.42±80.52)μmol/L, P=0.002). The multivariate logistic regression analysis showed that the elevated level of serum uric acid was an independent risk factors for total MRI burden of CSVD ( β=0.005, OR=1.005, 95% CI=1.001-1.009, P=0.019). The patients with CSVD were equally divided into four group based on the serum uric acid concentration.After controlling the confounding factors, with the increase of uric acid level, the risk of aggravating total MRI burden score of CSVD increased, and the difference was statistically significant( P=0.001). Serum uric acid(for each quartile increase)was an independent risk factor for total MRI burden in male patients with CSVD( β=0.482, OR=1.619, 95% CI=1.125-2.330, P=0.010), while there was no significant difference in female patients( P=0.070). Conclusion:Serum uric acid level is a risk factor for increasing the total MRI burden in male patients with CSVD, but this effect is not found in female patients with CSVD.
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Objective:To explore the correlation between enlarged perivascular spaces and other imaging markers of cerebrovascular disease in patients with ischemic stroke.Methods:Totally 287 patients with ischemic stroke hospitalized in neurology department from January 2018 to January 2019 were selected. According to the severity of EPVS in different parts of the brain, the correlations between the severity of EPVS in different parts of the brain and cerebral microbleeds (CMBs), white matter hyperintensity (WMH), lacunar infarcts (LIs) were analyzed. SPSS 22.0 software was used for analysis. Chi-square test, independent sample t-test, rank-sum test and non parametric Mann-Whitney U test were used for group comparison, and Logistic regression analysis was used for multivariate analysis. Results:EPVS was common and severe in patients with ischemic stroke. Periventricular white matter hyperintensity(PWMH)( β=1.604, P<0.001, OR=4.971, 95% CI=2.015-12.263), CMBs ( β=1.224, P=0.018, OR=3.339, 95% CI=1.232-9.383) and LIs ( β=0.626, P=0.047, OR=1.871, 95% CI=1.009-3.470) were independent risk factors for BG-EPVS. PWMH ( r=0.614), DWMH ( r=0.622), LIs ( r=0.532) were positively correlated with the severity of BG-EPVS (all P<0.01). Conclusion:The imaging makers of CSVD are related to BG-EPVS, which can affect the severity of brain BG-EPVS in patients with ischemic stroke.
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Post-stroke cognitive impairment (PSCI) directly affects the outcome of patients with stroke. Enlarged perivascular spaces (EPVS) suggest the impairment of brain clearance mechanism and may affect cognitive function. More and more studies have confirmed that the presence of EPVS will aggravate PSCI. This article reviews the relationship between EPVS and PSCI.
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A large number of studies have shown that the elevated lipoprotein (a) is a risk factor for ischemic stroke, but the specific mechanism is still unclear. Therefore, this article reviews the role of elevated lipoprotein (a) in ischemic stroke, its mechanism, and intervention measures.
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The perivascular space is formed by the pia mater around the blood vessels and participates in the fluid exchange and waste clearance in the brain. The enlarged perivascular space (EPVS) indicates the disorder of brain clearance mechanism, which is closely related to the occurrence and development of a variety of clinical diseases. In recent years, there are a lot of studies on the pathogenesis and influencing factors of EPVS. This article reviews its anatomy, neuroimaging, pathogenesis, and risk factors.
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Vascular cognitive impairment is the only cognitive impairment disease that can be intervened at present. In recent years, the research on its genetic factors has attracted much attention. Among them, apolipoprotein E (ApoE) and its genotypes are closely associated with lipid metabolism, β-amyloid aggregation and deposition, the changes of brain structure and function, and are closely correlated with the pathogenesis of dementia. This article discusses some possible mechanisms of ApoE and its genotypes affecting cognitive function, in order to provide reference for the management of cognitive function in patients with vascular cognitive impairment.
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Objective:To investigate the effects of butylphthalide(NBP) on cognitive function and Nrf2 / SIRT3 signal pathway in vascular dementia (VD) mice.Methods:Wild-type mice (Nrf2 + /+ ) were divided into sham group, model group (VD group), butylphthalide treatment group (Nrf2 + /+ NBP group), and Nrf2 gene knockout mice (Nrf2 -/-) were divided into Nrf2 -/-model group (Nrf2 -/-VD group) and Nrf2 -/-treatment group (Nrf2 -/-NBP group). Both the model group and the treatment group were repeated.The bilateral common carotid arteries were ligated three times to establish a mouse model of cognitive dysfunction caused by cerebral ischemia-reperfusion.The sham group only isolated the bilateral common carotid arteries and threaded the wires, but did not block blood flow.Morris water maze experiment was used to analyze the cognitive function of mice.HE staining was used to observe the changes of neuron morphology and structure in CA1 region of hippocampus, and immunohistochemical analysis was used to analyze the positive expression of caspase 3 and caspase 9 in mouse CA1 region of hippocampus.Western blot was used to detect mouse hippocampus Nrf2, p62, LC3, SIRT3 protein expression. Results:(1) In Morris water maze experiment: compared with VD group, the escape latency of Sham group and Nrf2 + /+ NBP group was significantly shorter on the 5th day ((20.69±8.91) s, (7.58±9.47)s, (8.41±12.20)s; q=3.58, 5.07, both P<0.05), and the percentage of stay time in target quadrant was significantly increased ((16.80±3.27)%, (25.25±5.51)% and (24.18±6.46)%; q=3.36, 4.43, both P<0.05). Compared with VD group, the escape latency of Nrf2 -/- VD group was significantly prolonged on the 5th day ((33.71±9.05) s), and the percentage of stay time in target quadrant was significantly reduced ((10.84±3.26)%)( q=3.56, 3.58; both P<0.05). Compared with Nrf2 -/- VD group, the escape latency and the percentage of stay time in target quadrant in Nrf2 -/- NBP group had no significant difference ( P>0.05). (2) Pathological results showed that, compared with VD group, the damage of pyramidal neurons in CA1 area of hippocampus in Sham group and Nrf2 + /+ NBP group was lighter, and that in Nrf2 -/- VD group was more serious, and the improvement of neuron morphology was not obvious after NBP treatment.(3) The expression of apoptosis: compared with VD group, the expression of caspase-3 and caspase-9 in the CA1 area of hippocampus in Sham group and Nrf2 + /+ NBP group were significantly lower, and those in Nrf2 -/-VD group were significantly higher ( t=3.48, 2.95, 3.46, 2.93, -2.99, -3.77, all P<0.01). Compared with Nrf2 -/-VD group, the expression of caspase- 3 and caspase-9 in the CA1 area of hippocampus in Nrf2 -/-NBP group were not significantly changed (both P>0.05). (4) Expression of related proteins: compared with VD group, Nrf2, SIRT3, p62 protein expression increased, LC3II/I ratio decreased in Nrf2 + /+ NBP group( t=-3.24, -4.04, -4.03, 3.62, all P<0.01); Nrf2, LC3II/ I ratio decreased, SIRT3, p62 protein expression increased in Sham group( t=3.44, 4.72, -3.52, -4.19, all P<0.01); Nrf2, SIRT3, p62 protein expression decreased and LC3II/I ratio increased in Nrf2 -/-VD group( t=9.14, 4.20, 4.30, -3.78, all P<0.01); Compared with Nrf2 -/- NBP, the expression of Nrf2, SIRT3, p62 decreased, and LC3II/I ratio increased in Nrf2 -/-VD group( t=2.40, 3.24, 1.21, -1.16, all P<0.01). The expression of Nrf2, SIRT3, p62 protein in Nrf2 + /+ NBP group increased, and the ratio of LC3II/ I decreased ( t=-3.29, -5.00, 6.24, all P<0.01). Conclusion:Butylphthalide can reduce the apoptotic damage in hippocampus of VD mice and improve cognitive dysfunction caused by repeated ischemia-reperfusion injury.Regulating Nrf2 / SIRT3 pathway to inhibit hippocampal neuronal apoptosis and autophagy may be its role mechanism.
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At present, the main treatment strategy for acute ischemic stroke is to recanalize the occluded blood vessels through drug or endovascular interventional therapy, and to save the ischemic penumbra is the key of the treatment, but due to the factors such as time window and indications, some patients cannot benefit from them. NeuroFlo technology can redistribute blood flow in body, increase intracranial blood supply, promote the establishment of collateral circulation around infarctions, effectively save ischemic penumbra, and ultimately improve the long-term prognosis of patients.
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Ischemic stroke has a higher disability and mortality rate. Good collateral circulation is beneficial to improve the success rate of ischemic stroke reperfusion, and is associated with good outcome. Collateral blood flow can prolong the survival time of brain tissue after occlusion of the intracranial artery, so improving collateral blood flow may become a potential therapeutic target for ischemic stroke.
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Cerebral microinfarct is a pathological manifestation of cerebral small vessel disease, which is common in the elderly, and is closely related to cognitive impairment and dementia. Therefore, it has received increasing attention in recent years. This article reviews the risk factors, neuroimaging, and clinical significance of cerebral microinfarct.
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Haze pollution is a mixture of many substances,the main components of which are sulfur dioxide,nitrogen oxides and particulate matter (PM). The study found that PM2. 5 not only affects the respir-atory and cardiovascular system,but also affects cognitive function,resulting in cognitive impairment such as memory loss and executive function decline. With the increase of PM2. 5 concentration,cognitive function gradually declines. Haze can cause organic changes in brain tissue. Studies have shown that haze can cause inflammation,oxidative stress response,neurodegeneration and other central nervous system damage,and lead to cognitive impairment by interfering with gene expression and regulation process. Haze increases the risk of cardiovascular and cerebrovascular diseases,mediates emotional and behavioral changes,thus indirectly af-fecting cognitive function. Therefore,in areas with severe haze,it is necessary to take more active measures to reduce the degree of haze and minimize haze damage.
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The incidence of vascular cognitive impairment (VCI) is increasing year by year,and early intervention and treatment for VCI can effectively reduce the occurrence of vascular dementia.The application of repetitive transcranial magnetic stimulation (rTMS) opens a new window for the treatment of VCI.This article reviews the efficacy,biological mechanism and safety of rTMS in the treatment of VCI.
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Perivascular spaces (PVS) are an important part of the glymphatic system of the brain.Enlarged PVS (EPVS) may be an early manifestation of brain microvascular diseases and brain clearance mechanism disorders.There is growing evidence that EPVS plays an important role in the development and progression of cognitive impairment and may be its early warning sign.This article reviews the relationship between EPVS and cognitive impairment.