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Dementia is one of the age-related diseases with the fastest increase in incidence. With the increasingly severe aging problem of the population, it further exacerbates the demand and burden of the healthcare system. Red blood cell distribution width (RDW) is an easily obtainable blood routine indicator that reflects the variability of red blood cell size. As an early marker of dementia risk, researches have shown an association between white matter hyperintensities (WMHs) and RDW. This article reviews the relationship between RDW and WMHs.
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Cerebral small vessel disease (CSVD) is one of the main causes of cognitive impairment and decreased the quality of daily life in the elderly. Researches have shown that CSVD is closely associated with autonomic nervous function. Patients with CSVD may be accompanied by cardiovascular, endocrine, gastrointestinal, urination, sleep disorders and other autonomic dysfunction.
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Spontaneous intracerebral hemorrhage (ICH) is the second common subtype of stroke, characterized by high morbidity, mortality, and disability. Cerebral small vessel disease (CSVD) refers to a series of clinic, imaging, and pathological syndromes caused by various causes that affect small arteries, arterioles, capillaries, and small venules in the brain. In recent years, there has been increasing research on the correlation between CSVD and ICH recurrence and outcomes. This article mainly reviews the relationship between CSVD imaging markers and ICH, in order to have a deeper understanding of ICH.
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Optical coherence tomography-based angiography (OCTA) is a novel non-invasive technique for quantitatively evaluating retinal microvascular perfusion. Due to the similar embryonic origin, anatomical characteristics, and physiological characteristics of the retina and cerebral small vessels, changes in retinal microvasculature may provide a new perspective for studying the mechanisms of cerebral small vessel diseases. This article summarizes the application of OCTA in cerebrovascular diseases, aiming to evaluate whether OCTA can become an effective tool for early prediction of the occurrence of cerebrovascular disease and monitoring disease changes.
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Objective:To investigate the correlation between serum lipoprotein (a) [LP(a)] and the severity of white matter hyperintensities (WMHs) in the middle-aged and elderly people in the community.Methods:Consecutive middle-aged and elderly residents residing in the community underwent physical examinations in the Affiliated Jiangning Hospital of Nanjing Medical University from June 2016 to August 2021 were retrospectively collected. Fasting venous blood was collected on the next day of admission to detect the level of Lp(a). During hospitalization, cranial MRI examination was performed and the severity of WMHs was graded using the Fazekas visual scoring method. Ordinal multivariate logistic regression analysis was used to determine independent related factors for the severity of WMHs.Results:A total of 1 752 patients were included in the analysis. There were 969 males (55.31%) and 783 females (44.69%). Their age was 66.18±10.32 years old. There were 1 167 patients (66.61%) in the mild WMHs group, 407 (23.23%) in the moderate WMHs group, and 178 (10.16%) in the severe WMHs group. Ordinal multivariable logistic regression analysis showed that after adjusting for confounding factors, a higher serum Lp(a) level was independently related to the severity of WMHs (with the first quartile as a reference, the third quartile: odds ratio 1.441, 95% confidence interval 1.050-1.976, P=0.023; the fourth quartile: odds ratio 1.717, 95% confidence interval 1.252-2.354, P=0.001). Conclusion:Serum Lp(a) is independently correlated with the severity of WMHs.
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Cerebral small vessel disease (CSVD) is a group of pathological, imaging and clinical syndromes involving small cerebral vessels with different causes. The incidence rate of CSVD increases with age and is the most important cause of vascular cognitive impairment. Different diffusion imaging techniques can quantify white matter microstructure damage by revealing the diffusion movement of water molecules in specific brain tissues, explore the basis and biophysical mechanisms of tissue change, and have important value for the mechanism research, early diagnosis, progression risk, and therapeutic evaluation of cognitive impairment related to CSVD. This article reviews the research progress of diffusion magnetic resonance imaging in CSVD related cognitive impairment.
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Cerebral small vessel disease (CSVD) is an important cause of ischemic stroke and vascular dementia, which brings heavy burden to families and society. The prevention and treatment of CSVD has always been a research hotspot, but its pathogenesis is still not completely clear. This article reviews the pathogenesis of CSVD, including chronic cerebral hypoperfusion, blood-brain barrier dysfunction, vascular endothelial dysfunction, interstitial fluid reflux disorder, inflammatory response, and genetic factors, in order to provide more sufficient theoretical basis for early intervention and treatment of CSVD.
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Gut microbiota is involved in maintaining intestinal homeostasis. The bidirectional communication between intestinal flora and brain can also be conducted through the neuro-immune-endocrine network, namely, the "microbiota-gut-brain axis". A number of studies have shown that the "microbiota-gut-brain axis" disorder plays an important role in the occurrence, development and prognosis of some cerebrovascular diseases, such as cerebral small vessel disease and stroke. This article introduces the latest research progress of the relationship between gut microbiota and cerebrovascular diseases, so as to provide more ideas and options for the treatment of cerebrovascular diseases.
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Objective:To investigate the correlation between paroxysmal slow-wave events (PSWEs) and cerebral small vessel disease (CSVD) and CSVD-related cognitive impairment.Methods:Patients with CSVD visited Weihai Municipal Hospital from March 2021 to April 2022 were included, and sex- and age-matched healthy controls were recruited for cross-sectional analysis. The patients with CSVD were further divided into cognitive impairment group and non-cognitive impairment group. The self-developed Python script was used to detect the PSWE parameters in electroencephalogram records. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to evaluate cognitive function. Multivariate logistic regression analysis was used to determine whether PWSE parameters were the independent related factors of CSVD and CSVD-related cognitive impairment. Multiple linear regression analysis was used to determine the correlation between the PSWE parameters and overall cognitive function (MoCA total score) in patients with CSVD. Results:A total of 76 patients with CSVD (including 41 patients with cognitive impairment and 35 patients without cognitive impairment) and 45 healthy controls were included. Compared with the healthy control group, PWSEs in the F3 (left frontal area) and O1 (left occipital area) regions of the CSVD group occurred more frequently and lasted longer (all P<0.05). Multivariate logistic regression analysis showed that the frequency (odds ratio [ OR] 1.080, 95% confidence interval [ CI] 1.023-1.140; P=0.005) and duration ( OR 1.006, 95% CI 1.001-1.011; P=0.023) of PWSEs in the left frontal area, as well as the frequency ( OR 1.052, 95% CI 1.010-1.095; P=0.014) and duration ( OR 1.003, 95% CI 1.000-1.006; P=0.028) of PWSEs in the left occipital region were the independent related factors for CSVD. The frequency ( OR 1.106, 95% CI 1.033-1.183; P=0.004) and duration ( OR1.010, 95% CI 1.003-1.017; P=0.004) of PWSEs in the left frontal area were the independent risk factors for cognitive impairment in patients with CSVD. Multiple linear regression analysis showed that the frequency ( β= –0.242, P=0.045) and duration ( β= –0.235, P=0.046) of PWSEs in the left frontal region were negatively correlated with the overall cognitive function score in patients with CSVD. Conclusions:The frequency and duration of PSWEs in some brain regions of patients with CSVD increase, and there is an independent correlation between PSWEs and cognitive impairment, suggesting that the damage of blood-brain barrier may participate in the pathogenesis of cognitive impairment in patients with CSVD.
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Cerebral small vessel disease (CSVD) is a series of clinical, imaging, and pathological syndromes resulting from various etiologies affecting small arteries (microarteries, capillaries, microvenules, and small veins in the brain). The diagnosis of CSVD is based on imaging presentations, but the high cost and bleeding risk of cranial imaging methods make the diagnosis of rare CSVD more difficult. Retinal vessels are the only vasculature visible in vivo and share anatomical and embryological features with small brain vessels. Retinal vascular abnormalities have been shown to exist in rare CSVD such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral amyloid angiopathy (CAA) and moyamoya disease (MMD). Retinal vascular examination may provide new ideas for the study of rare CSVD.
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Cerebral microbleed (CMB) is a type of cerebral small vessel disease (CSVD). Recently studies have found that there is a certain relationship between CMB and cognitive impairment. This article mainly reviews the etiology of CMB, the relationship between CMB and cognitive impairment, CMB and cognitive disorders and the possible mechanism of CMB-related cognitive impairment, in order to improve the understanding of cognitive impairment caused by CMB.
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Objective:To investigate the clinical value of high-frequency ultrasound combined with virtual touch tissue imaging and quantification in the assessment of limb muscle tension after stroke in patients.Methods:A total of 31 patients with stroke who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to May 2022 and 41 healthy controls who concurrently underwent physical examination in the same hospital were included in this study. Before rehabilitation treatment, the shear wave velocity of the main muscle groups of the limbs was measured using virtual touch tissue imaging and quantification in all participants. The shear wave velocity of the main muscle groups was compared between the affected and healthy sides of patients between two sides of patients. The patient's muscle tension was evaluated using the modified Ashworth Scale. The shear wave velocity of the affected muscle groups in patients was correlated with the modified Ashworth Scale score.Results:There were no significant differences in the shear wave velocities of the main muscle groups of upper (biceps, flexor digitorum sublimis, flexor digitorum profundus) and lower [medial head of the gastrocnemius muscle, lateral head of the gastrocnemius muscle] limbs between the left [(2.46 ± 0.26) m/s, (2.81 ± 0.50) m/s, (2.96 ± 0.31) m/s, (2.49 ± 0.44) m/s, (2.21 ± 0.20) m/s] and right [(2.42 ± 0.29) m/s, (2.80 ± 0.47) m/s, (3.02 ± 0.36) m/s, (2.54 ± 0.37) m/s, (2.18 ± 0.17) m/s] sides in healthy controls ( t = 0.78, 0.04, 0.83, 0.58, 1.15, P = 0.435, 0.967, 0.405, 0.558, 0.216). The shear wave velocities of the main muscle groups of upper [flexor digitorum sublimis (3.74 ± 0.67) m/s, flexor digitorum profundus (3.64 ± 0.60) m/s), biceps (3.63 ± 0.64) m/s] and lower [medial head of the gastrocnemius muscle (3.28 ± 0.61) m/s, lateral head of the gastrocnemius muscle (2.90 ± 0.37) m/s] limbs on the affected side in patients with stroke were significantly higher than (2.56 ± 0.40) m/s, (2.67 ± 0.38) m/s, (2.78 ± 0.41) m/s, (2.30 ± 0.21) m/s, (2.25 ± 0.23) m/s on the healthy side ( t = 11.81, 8.21, 8.75, 8.91, 10.43, all P < 0.001). The shear wave velocities of the main muscle groups of the upper (flexor digitorum sublimis, flexor digitorum profundus, and biceps) and lower (medial head of the gastrocnemius muscle and lateral head of the gastrocnemius muscle) limbs were positively correlated with the modified Ashworth Scale score ( r = 0.77, 0.70, 0.72, 0.74, 0.78, P = 0.007, 0.029, 0.021, 0.016, 0.001). Conclusion:Monitoring the shear wave velocities of the main muscle groups of the upper and lower limbs using high-frequency ultrasound combined with virtual touch tissue imaging and quantification can effectively reflect the change in limb muscle tension of patients with stroke, which is highly valuable for evaluating rehabilitation efficacy and prognosis in patients with stroke.
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Cerebral small vessel disease (CSVD) is a group of diseases that involve the structure and function of cerebral small perforator arteries, arterioles, venules and capillaries, thus causing a series of clinical symptoms and imaging manifestation. Although the pathogenesis of CSVD is not completely clear, more and more evidence indicates that the elevated level of serum inflammatory markers plays an important role in the occurrence and development of CSVD. This article reviews the correlation between serum inflammatory markers and CSVD.
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Cerebral small vessel disease (CSVD) refers to a series of clinical, imaging and pathological syndromes of cerebral arterioles, capillaries, venules, as well as perivascular brain parenchyma caused by various etiologies, and is one of the important causes of vascular cognitive impairment and dementia. The onset of CSVD is insidious, and the early diagnosis mainly depends on imaging examination. This article reviews the effects of different imaging markers of CSVD on cognitive function and their pathophysiological mechanism.
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Cerebral small vessel disease (CSVD) is a common and slowly progressive cerebrovascular disease. Its pathological mechanism involves vascular endothelial dysfunction, blood-brain barrier destruction, neuronal apoptosis, glial cell activation, and inflammatory reaction. Neurovascular unit is the basic unit of brain structure and function, and its pathological changes are closely associated with many cerebrovascular diseases. At present, the damage mechanism of neurovascular unit in CSVD has been paid more and more attention. This article reviews the damage mechanism of neurovascular unit in CSVD.
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Cerebral small vessel disease (CSVD) is the main cause of vascular cognitive impairment. Its mechanism is not yet fully clear, which may be associated with vascular endothelial dysfunction and the destruction of blood-brain barrier. In recent years, some studies have been conducted on biomarkers of cognitive impairment in patients with CSVD. This article reviews the biomarkers of cognitive impairment in patients with CSVD from the aspects of inflammatory response, oxidative stress, vascular endothelial dysfunction, endocrine, nervous system damage, and microRNAs.
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Objective:To investigate the correlation between migraine and overall burden of cerebral small vessel disease (CSVD).Methods:Migraine patients who visited the headache clinic of Jiangyin People's Hospital from January 2021 to October 2021 were selected as the case group, and healthy people who had no previous primary headache of any type and matched age and sex in the same period were selected as the control group. Various CSVD phenotypes, including vasogenic lacuna, white matter hyperintensities (WMHs), cerebral microbleeds (CMBs) and enlarged perivascular space (EPVS) were detected by the multimodal MRI, and the overall burden score of CSVD was calculated. The detection rates of CSVD and its phenotypes and the overall burden of CSVD were compared between the case group and the control group. The subjects with CSVD were divided into mild group, moderate group and severe group according to the overall burden score of CSVD. The independent influencing factors of the overall burden of CSVD were identified by the ordinal multi-classification logistic regression model. Results:A total of 109 migraine patients and 100 healthy controls were enrolled. The detection rate of CSVD (65.13% vs. 46.00%; P=0.005) and the proportion of patients with severe CSVD overall burden (24.77% vs. 10.00%; P=0.005) in the case group were significantly higher than those in the control group. In terms of specific CSVD phenotypes, the detection rates of WMHs (48.62% vs. 33.00%; P=0.022) and CMBs (35.80% vs. 19.00%; P=0.007) in the case group were significantly higher than those in the control group, while there were no significant differences in vasogenic lacuna and moderate to severe EPVS. Univariate analysis showed that the overall burden of CSVD was significantly associated with age, migraine, hypertension, baseline diastolic blood pressure, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (all P<0.05). Multivariate logistic analysis showed that age (odds ratio [ OR] 3.731, 95% confidence interval [ CI] 1.051-1.217; P=0.001), migraine ( OR 2.812, 95% CI 1.045-5.124; P=0.012), hypertension ( OR 2.112, 95% CI 1.525-4.021; P=0.032), and LDL-C ( OR 2.512, 95% CI 1.541-4.312; P=0.023) were independently associated with the overall burden of CSVD. Conclusions:The detection rate of CSVD in migraine patients is higher than that in the general population, especially WMHs and CMBs. Migraine is independently associated with the overall burden of CSVD.
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Objective:To investigate the correlation between MRI markers of neurodegenerative diseases and vascular diseases and pre-stroke cognitive impairment (PSCI).Methods:Patients with minor acute ischemic stroke at first onset and aged ≥60 years admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University and the Department of Neurology, Linyi Jinluo Hospital from March 2019 to December 2021 were retrospectively enrolled. The imaging markers of cerebral small vessel disease and neurodegeneration were analyzed by dichotomy visual score. The former included cerebral white matter hyperintensities, vasogenic lacunar lesions, cerebral microbleeds, and enlarged perivascular space, and the latter included global cortical atrophy and medial temporal lobe atrophy. According to the score of Information Questionnaire on Cognitive Decline in the Elderly (IQCODE), the patients were divided into PSCI group (≥3.31 points) and non-PSCI group (<3.31 points). The clinical baseline data and MRI markers of both groups were compared. Multivariate logistic regression model was used to analyze the correlation between MRI markers and PSCI, and receiver operator characteristic (ROC) curve was used to analyze the predictive value of MRI markers to PSCI. Results:A total of 221 patients were enrolled in the study, including 77 patients (34.8%) in the PSCI group and 144 (65.2%) in the non-PSCI group. Univariate analysis showed that there were significant differences in age, years of education, pathological white matter hyperintensities, medial temporal lobe atrophy, and the proportion of patients with ≥1 abnormal MRI markers between the two groups (all P<0.05). Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.089, 95% confidence interval [ CI] 1.034-1.146; P=0.001), years of education <6 years ( OR 3.134, 95% CI 1.534-6.401; P=0.002), medial temporal lobe atrophy ( OR 2.911, 95% CI 1.385-6.121; P=0.005), and presence of ≥1 abnormal MRI markers ( OR 2.823, 95% CI 1.305-5.938; P=0.007) were the independent risk factors for PSCI. ROC curve analysis showed that the area under the curve of medial temporal lobe atrophy and the presence of ≥1 abnormal MRI markers for predicting PSCI were both smaller (0.595 and 0.584 respectively), but the area under the curve was the largest when the two and years of education were combined (0.818, 95% CI 0.756-0.880; P<0.001), and its sensitivity and specificity for predicting PSCI were 79.9% and 71.4% respectively. Conclusions:The incidence of PSCI is high. Medial temporal lobe atrophy combined with other abnormal MRI markers has a certain predictive value for PSCI.
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Objective:To investigate the predictive value of triglyceride-glucose (TyG) index for the overall burden of cerebral small vessel disease (CSVD).Methods:Consecutive patients with CSVD admitted to Jiaxing First Hospital from July 2019 to January 2021 were enrolled. MRI was used to conduct the overall burden score of CSVD. The difference of TyG index and other risk factors between high burden group (3-4 points) and low burden group (0-2 points) was analyzed. The independent predictors of the high burden of CSVD were determined by the multivariate logistic regression analysis, and the predictive value of TyG index for the high burden of CSVD was evaluated by the receiver operating characteristic (ROC) curve. Results:A total of 165 patients with CSVD were enrolled, including 103 patients (62.4%) in the low burden group and 62 (37.6%) in the high burden group. The proportion of patients with previous stroke or transient ischemic attack, as well as age, fasting blood glucose, glycosylated hemoglobin and TyG index in the high burden group were significantly higher than those in the low burden group ( P<0.05). Multivariate logistic regression analysis showed that TyG index (odds ratio [ OR] 4.584, 95% confidence interval [ CI] 2.180-8.887; P=0.001) and age ( OR 1.075, 95% CI 1.025-1.128; P=0.003) were the independent predictors of high burden of CSVD. The ROC curve showed that the area under the curve of TyG index for predicting the high burden of CSVD was 0.69 (95% CI 0.60-0.77). The optimal cutoff value was 8.5, and its sensitivity and specificity for predicting the high burden of CSVD were 72.6% and 64.1%, respectively. Conclusion:TyG index is associated with the overall burden of CSVD and has certain predictive value for the high burden of CSVD.
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Cerebral small vessel disease (CSVD) refers to a series of pathological, imaging and clinical syndrome caused by various etiologies affecting cerebral arterioles, venules and capillaries. The main imaging features of CSVD include white matter hyperintensities, cerebral microbleeds, lacunar cerebral infarction, enlarged perivascular space, and brain atrophy. Deep medullary veins (DMVs) are small parenchymal veins around the lateral ventricle, which participate in the venous return from deep white matter veins to subependymal veins. In recent years, more and more studies have shown that DMVs are closely associated with the occurrence and development of CSVD. This article reviews the role of DMVs in CSVD, and provides ideas for further exploring the pathogenesis and imaging markers of CSVD.