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SUMMARY: Striae distensae, or stretch marks, are common linear lesions of atrophic skin characterized histologically by epidermal atrophy, absent rete ridges, and alterations in connective tissue architecture. Hormonal excess, mechanical stress, and genetic predisposition are all associated with striae distensae, but their exact pathogenesis remains unknown. Despite a multitude of options, no single treatment has yet proven effective. In this article, the authors describe an up-to-date overview of striae distensae in terms of their etiology, pathophysiology, and therapeutic options. Further research is required to better elucidate their pathophysiology and to develop targeted effective treatments.
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Calidad de Vida , Piel/patología , Estrías de Distensión/etiología , Administración Cutánea , Atrofia/epidemiología , Atrofia/etiología , Atrofia/psicología , Atrofia/terapia , Terapia Combinada/métodos , Dermabrasión/métodos , Fármacos Dermatológicos/administración & dosificación , Estética , Humanos , Terapia por Láser/métodos , Prevalencia , Estrías de Distensión/epidemiología , Estrías de Distensión/psicología , Estrías de Distensión/terapia , Resultado del TratamientoRESUMEN
BACKGROUND: Previous research has identified a small subgroup of older adults that maintain a high level of cognitive functioning well into advanced age. Investigation of those with superior cognitive performance (SCP) for their age is important, as age-related decline has previously been thought to be inevitable. OBJECTIVE: Preservation of cortical thickness and volume was evaluated in 76 older adults with SCP and 100 typical older adults (TOAs) assessed up to five times over six years. METHODS: Regions of interest (ROIs) found to have been associated with super-aging status (a construct similar to SCP status) in previous literature were investigated, followed by a discovery phase analyses of additional regions. SCPs were aged 70â+âat baseline, scoring at/above normative memory (CVLT-II) levels for demographically similar individuals aged 30-44 years old, and in the unimpaired range for all other cognitive domains over the course of the study. RESULTS: In linear mixed models, following adjustment for multiple comparisons, there were no significant differences between rates of thinning or volume atrophy between SCPs and TOAs in previously identified ROIs, or the discovery phase analyses. With only amyloid-ß negative individuals in the analyses, again there were no significant differences between SCPs and TOAs. CONCLUSION: The increased methodological rigor in classifying groups, together with the influence of cognitive reserve, are discussed as potential factors accounting for our findings as compared to the extant literature on those with superior cognitive performance for their age.
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Envejecimiento/patología , Atrofia/patología , Grosor de la Corteza Cerebral , Corteza Cerebral/patología , Cognición/fisiología , Anciano , Anciano de 80 o más Años , Envejecimiento/psicología , Atrofia/diagnóstico por imagen , Atrofia/psicología , Corteza Cerebral/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Pruebas Neuropsicológicas , Tamaño de los Órganos/fisiologíaRESUMEN
BACKGROUND: Cerebral amyloid angiopathy (CAA) contributes to brain neurodegeneration and cognitive decline, but the relationship between these two processes is incompletely understood. OBJECTIVE: The purpose of this study is to examine cortical thickness and its association with cognition and neurodegenerative biomarkers in CAA. METHODS: Data were collected from the Functional Assessment of Vascular Reactivity study and the Calgary Normative Study. In total, 48 participants with probable CAA, 72 cognitively normal healthy controls, and 24 participants with mild dementia due to AD were included. Participants underwent an MRI scan, after which global and regional cortical thickness measurements were obtained using FreeSurfer. General linear models, adjusted for age and sex, were used to compare cortical thickness globally and in an AD signature region. RESULTS: Global cortical thickness was lower in CAA compared to healthy controls (mean difference (MD) -0.047âmm, 95% confidence interval (CI) -0.088, -0.005, pâ=â0.03), and lower in AD compared to CAA (MD -0.104âmm, 95% CI -0.165, -0.043, pâ=â0.001). In the AD signature region, cortical thickness was lower in CAA compared to healthy controls (MD -0.07âmm, 95% CI -0.13 to -0.01, pâ=â0.02). Within the CAA group, lower cortical thickness was associated with lower memory scores (R2â=â0.10; pâ=â0.05) and higher white matter hyperintensity volume (R2â=â0.09, pâ=â0.04). CONCLUSION: CAA contributes to neurodegeneration in the form of lower cortical thickness, and this could contribute to cognitive decline. Regional overlap with an AD cortical atrophy signature region suggests that co-existing AD pathology may contribute to lower cortical thickness observed in CAA.
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Grosor de la Corteza Cerebral , Angiopatía Amiloide Cerebral/patología , Corteza Cerebral/patología , Cognición/fisiología , Anciano , Anciano de 80 o más Años , Atrofia/diagnóstico por imagen , Atrofia/patología , Atrofia/psicología , Angiopatía Amiloide Cerebral/diagnóstico por imagen , Angiopatía Amiloide Cerebral/psicología , Corteza Cerebral/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen , Pruebas NeuropsicológicasRESUMEN
OBJECTIVE: To evaluate the relationship between circulating phenylalanine and brain function as well as neuropsychiatric symptoms in adults with phenylketonuria. METHODS: In this prospective cross-sectional study, early-treated patients with phenylketonuria older than 30 years and age- and sex-matched controls were included. Extensive neurologic evaluation, neuropsychological and behavioral testing, sensory and motor evoked potentials, and MRI were performed. CSF concentrations of neurodegenerative markers were evaluated in addition in a subset of 10 patients. RESULTS: Nineteen patients with phenylketonuria (median age 41 years) with different phenylalanine levels (median 873 µmol/L) entered the study. They showed higher prevalence of neurologic symptoms, cognitive and behavioral abnormalities, autonomic dysfunction, alterations in neurophysiologic measures, and atrophy in putamen and right thalamus compared to controls. In CSF, patients with phenylketonuria exhibited higher ß-amyloid 1-42 (p = 0.003), total tau (p < 0.001), and phosphorylated tau (p = 0.032) levels compared to controls. Plasma phenylalanine levels highly correlated with the number of failed neuropsychological tests (r = 0.64, p = 0.003), neuropsychiatric symptoms (r = 0.73, p < 001), motor evoked potential latency (r = 0.48, p = 0.030), and parietal lobe atrophy. CONCLUSIONS: Our study provides strong evidence for a correlation between phenylalanine levels and clinical, neuropsychological, neurophysiologic, biochemical, and imaging alterations in adult patients with phenylketonuria.
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Cognición/fisiología , Fenilalanina/sangre , Fenilcetonurias/sangre , Putamen/diagnóstico por imagen , Tálamo/diagnóstico por imagen , Adulto , Atrofia/sangre , Atrofia/diagnóstico por imagen , Atrofia/psicología , Estudios Transversales , Potenciales Evocados Motores/fisiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Pruebas Neuropsicológicas , Fenilcetonurias/diagnóstico por imagen , Fenilcetonurias/psicología , Estudios ProspectivosRESUMEN
Negative and positive emotions are known to shape decision-making toward more or less impulsive responses, respectively. Decision-making and emotion processing are underpinned by shared brain regions including the ventromedial prefrontal cortex (vmPFC) and the amygdala. How these processes interact at the behavioral and brain levels is still unclear. We used a lesion model to address this question. Study participants included individuals diagnosed with behavioral-variant frontotemporal dementia (bvFTD, n = 18), who typically present deficits in decision-making/emotion processing and atrophy of the vmPFC, individuals with Alzheimer's disease (AD, n = 12) who present with atrophy in limbic structures and age-matched healthy controls (CTRL, n = 15). Prior to each choice on the delay discounting task participants were cued with a positive, negative or neutral picture and asked to vividly imagine witnessing the event. As hypothesized, our findings showed that bvFTD patients were more impulsive than AD patients and CTRL and did not show any emotion-related modulation of delay discounting rate. In contrast, AD patients showed increased impulsivity when primed by negative emotion. This increased impulsivity was associated with reduced integrity of bilateral amygdala in AD but not in bvFTD. Altogether, our results indicate that decision-making and emotion interact at the level of the amygdala supporting findings from animal studies.
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Enfermedad de Alzheimer/psicología , Toma de Decisiones/fisiología , Emociones/fisiología , Demencia Frontotemporal/psicología , Corteza Prefrontal/diagnóstico por imagen , Anciano , Enfermedad de Alzheimer/diagnóstico por imagen , Atrofia/diagnóstico por imagen , Atrofia/psicología , Femenino , Demencia Frontotemporal/diagnóstico por imagen , Humanos , Conducta Impulsiva/fisiología , Masculino , Persona de Mediana Edad , Pruebas NeuropsicológicasRESUMEN
INTRODUCTION: This work aims to characterize the sequence in which cognitive deficits appear in two dementia syndromes. METHODS: Event-based modeling estimated fine-grained sequences of cognitive decline in clinically-diagnosed posterior cortical atrophy (PCA) ( n=94 ) and typical Alzheimer's disease (tAD) ( n=61 ) at the UCL Dementia Research Centre. Our neuropsychological battery assessed memory, vision, arithmetic, and general cognition. We adapted the event-based model to handle highly non-Gaussian data such as cognitive test scores where ceiling/floor effects are common. RESULTS: Experiments revealed differences and similarities in the fine-grained ordering of cognitive decline in PCA (vision first) and tAD (memory first). Simulation experiments reveal that our new model equals or exceeds performance of the classic event-based model, especially for highly non-Gaussian data. DISCUSSION: Our model recovered realistic, phenotypical progression signatures that may be applied in dementia clinical trials for enrichment, and as a data-driven composite cognitive end-point.
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Enfermedad de Alzheimer/patología , Encéfalo/patología , Disfunción Cognitiva/patología , Modelos Teóricos , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/psicología , Atrofia/diagnóstico por imagen , Atrofia/patología , Atrofia/psicología , Encéfalo/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/psicología , Progresión de la Enfermedad , Humanos , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Structural magnetic resonance imaging (MRI) is routinely performed in patients with mild cognitive impairment (MCI), but diagnostic accuracy to detect early cerebral atrophy is limited. OBJECTIVE: To validate the visual entorhinal cortex atrophy (ERICA) rating scale regarding diagnosis, biomarker status, neuropsychological profile, and dementia risk in MCI. METHODS: The ERICA score was retrospectively assessed regarding its discrimination of MCI (nâ=â80) from subjective cognitive decline and Alzheimer's disease (AD) dementia (nâ=â60, respectively), its prediction of conversion to dementia (median follow-up 28 months) and amyloid/tau biomarker status, and its association with neuropsychological tests. RESULTS: The ERICA score achieved 97% positive predictive value (PPV) for the presence of MCI. Discrimination between MCI and AD dementia (area under the curve: 0.71) was comparable to volumetry, and superior to the medial temporal lobe atrophy (MTA) score (pâ=â0.006). The PPV of the ERICA score for conversion to dementia was 83%, equivalent to tau status. It achieved 90% PPV for conversion when combined with tau, and 100% negative predictive value with verbal recall. While no measure predicted the predominantly positive amyloid status, the ERICA score was at least comparable to volumetry, and superior to the MTA score in predicting tau positivity (92% PPV for phospho-tau). The ERICA score was associated with verbal learning and memory, and, unlike the MTA score, also with AD-specific deficits in cued verbal recall. CONCLUSION: The ERICA score is a simple and valuable tool to exploit structural MRI for diagnosis and prognosis in MCI and is non-inferior to volumetry.
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Disfunción Cognitiva/diagnóstico por imagen , Corteza Entorrinal/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Atrofia/diagnóstico por imagen , Atrofia/psicología , Disfunción Cognitiva/psicología , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Pronóstico , Estudios RetrospectivosRESUMEN
OBJECTIVE: To determine which pathologic process could be responsible for the acceleration of cognitive decline during the course of multiple sclerosis (MS), using longitudinal structural MRI, which was related to cognitive decline in relapsing-remitting MS (RRMS) and progressive MS (PMS). METHODS: A prospective cohort of 230 patients with MS (179 RRMS and 51 PMS) and 59 healthy controls was evaluated twice with 5-year (mean 4.9, SD 0.94) interval during which 22 patients with RRMS converted to PMS. Annual rates of cortical and deep gray matter atrophy as well as lesion volume increase were computed on longitudinal (3T) MRI data and correlated to the annual rate of cognitive decline as measured using an extensive cognitive evaluation at both time points. RESULTS: The deep gray matter atrophy rate did not differ between PMS and RRMS (-0.82%/year vs -0.71%/year, p = 0.11), while faster cortical atrophy was observed in PMS (-0.87%/year vs -0.48%/year, p < 0.01). Similarly, faster cognitive decline was observed in PMS compared to RRMS (p < 0.01). Annual cognitive decline was related to the rate of annual lesion volume increase in stable RRMS (r = -0.17, p = 0.03) to the rate of annual deep gray matter atrophy in converting RRMS (r = 0.50, p = 0.02) and annual cortical atrophy in PMS (r = 0.35, p = 0.01). CONCLUSIONS: These results indicate that cortical atrophy and cognitive decline accelerate together during the course of MS. Substrates of cognitive decline shifted from worsening lesional pathology in stable RRMS to deep gray matter atrophy in converting RRMS and to accelerated cortical atrophy in PMS only.
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Corteza Cerebral/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/psicología , Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/psicología , Adulto , Anciano , Atrofia/diagnóstico por imagen , Atrofia/epidemiología , Atrofia/psicología , Disfunción Cognitiva/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética/tendencias , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/epidemiología , Estudios ProspectivosRESUMEN
The hippocampus is a crucial pathological node for minimal hepatic encephalopathy (MHE) and it is associated with various cognitive impairments. Investigations on alterations involving hippocampal morphology and functional connectivity (FC) in MHE are limited. This study aimed to simultaneously evaluate hippocampal volume and FC alterations and their association with cognitive decline in MHE. Twenty-two cirrhotic patients with MHE, 31 cirrhotic patients without MHE (NHE), and 43 healthy controls underwent high-resolution T1-weighted imaging, resting-state functional magnetic resonance imaging, and cognition assessment based on Psychometric Hepatic Encephalopathy Score (PHES). The structural images were preprocessed using a voxel-based morphometry method, during which hippocampal volume was measured. The hippocampal connectivity network was identified using seed-based correlation analysis. Hippocampal volume and FC strength were compared across the three groups and correlated against the PHES results of the cirrhotic patients. Compared to the controls, MHE patients exhibited a significantly lower bilateral hippocampal volume. A slight decrease in hippocampal volume was obtained from NHE to MHE, but it did not reach statistically significance. In addition, the average FC strength of the bilateral hippocampal connectivity network was significantly lower in the MHE patients. In particular, the MHE patients showed a decrease in FC involving the left hippocampus to bilateral posterior cingulate gyrus and left angular gyrus. The MHE patients also showed FC reduction between the right hippocampus and bilateral medial frontal cortex. A progressive reduction in hippocampal FC from NHE to MHE was also observed. The bilateral hippocampal FC strength (but not hippocampal volume) was positively correlated with the PHES results of the cirrhotic patients. Our assessment of MHE patients revealed decreased hippocampal volume, which suggests regional atrophy, and reduced hippocampal connectivity with regions that are primarily involved in the default-mode network, thereby suggesting a functional disconnection syndrome. These alterations reveal the mechanisms underlying cognitive deterioration with disease progression.
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Cognición/fisiología , Encefalopatía Hepática/diagnóstico por imagen , Hipocampo/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Red Nerviosa/diagnóstico por imagen , Adulto , Atrofia/diagnóstico por imagen , Atrofia/psicología , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Encefalopatía Hepática/psicología , Humanos , Cirrosis Hepática/psicología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tamaño de los Órganos/fisiologíaRESUMEN
BACKGROUND: Non-amyloid mechanisms behind neurodegeneration and cognition impairment are unclear. Cerebrovascular disease (CVD) may play an important role in suspected non-Alzheimer's pathophysiology (SNAP), especially in Asia. OBJECTIVE: To examine the association between CVD and medial temporal lobe atrophy (MTA) in amyloid-ß negative patients with mild amnestic type dementia. METHODS: Thirty-six mild dementia patients with complete neuropsychological, cerebrospinal fluid (CSF) biomarker, and neuroimaging information were included. Only patients with clinically significant MTA were recruited. Patients were categorized based on their CSF Aß levels. Neuroimaging and neuropsychological variables were analyzed. RESULTS: Despite comparable MTA between Aß positive and negative patients, Aß-negative patients had significantly greater white matter hyperintensities (WMH; Total Fazekas Rating) than their Aß-positive counterparts (6.42 versus 4.19, pâ=â0.03). A larger proportion of Aß-negative patients also had severe and confluent WMH. Regression analyses controlling for baseline characteristics yielded consistent results. CONCLUSION: Our findings demonstrate that MTA is associated with greater CVD burden among Aß-negative patients with amnestic type dementia. CVD may be an important mechanism behind hippocampal atrophy. This has implications on clinical management strategies, where measures to reduce CVD may slow neurodegeneration and disease progression.
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Amnesia/patología , Atrofia/patología , Demencia/patología , Lóbulo Temporal/patología , Sustancia Blanca/patología , Anciano , Amnesia/líquido cefalorraquídeo , Amnesia/diagnóstico por imagen , Amnesia/psicología , Péptidos beta-Amiloides/líquido cefalorraquídeo , Atrofia/líquido cefalorraquídeo , Atrofia/diagnóstico por imagen , Atrofia/psicología , Demencia/líquido cefalorraquídeo , Demencia/diagnóstico por imagen , Demencia/psicología , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Pruebas Neuropsicológicas , Lóbulo Temporal/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagenRESUMEN
Units of measurement (e.g., metre, week, gram) are critically important concepts in everyday life. Little is known about how knowledge of units is represented in the brain or how this relates to other forms of semantic knowledge. As unit terms are intimately connected with numerical quantity, we might expect knowledge for these concepts to be supported by parietally-mediated representations of space, time and magnitude. We investigated knowledge for measurement units in patients with posterior cortical atrophy (PCA), who display profound impairments of spatial and numerical cognition associated with occipital and parietal lobe atrophy. Relative to healthy controls, PCA patients displayed impairments for a range of unit-based knowledge, including the ability to specify the dimension which a unit refers to (e.g., grams measure mass), to select the appropriate units to measure everyday quantities (e.g., grams for sugar) and to determine the relative magnitudes of different unit terms (e.g., gram is smaller than kilogram). In most cases, their performance was also significantly poorer than a patient control group diagnosed with typical Alzheimer's disease. Our results suggest that impairment to systems that code numerical and spatial magnitudes has an effect on non-numerical verbal knowledge for measurement units. Units of measurement appear to lie at the intersection of the brain's verbal and numerical semantic systems, making them a critical class of concepts in which to investigate how magnitude-based codes contribute to verbal semantic representation.
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Atrofia/psicología , Comprensión/fisiología , Conocimiento , Enfermedades Neurodegenerativas/psicología , Anciano , Atrofia/patología , Encéfalo/patología , Cognición , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/patología , Pruebas NeuropsicológicasRESUMEN
Chronic pain is associated with brain atrophy with limited evidence on its impact in the older adult's brain. We aimed to determine the associations between chronic pain and a brain aging biomarker in persons aged 60 to 83 years old. Participants of the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study (N = 47) completed demographic, psychological, and pain assessments followed by a quantitative sensory testing battery and a T1-weighted magnetic resonance imaging. We estimated a brain-predicted age difference (brain-PAD) that has been previously reported to predict overall mortality risk (brain-PAD, calculated as brain-predicted age minus chronological age), using an established machine-learning model. Analyses of covariances and Pearson/Spearman correlations were used to determine associations of brain-PAD with pain, somatosensory function, and psychological function. Individuals with chronic pain (n = 33) had "older" brains for their age compared with those without (n = 14; F[1,41] = 4.9; P = 0.033). Greater average worst pain intensity was associated with an "older" brain (r = 0.464; P = 0.011). Among participants with chronic pain, those who reported having pain treatments during the past 3 months had "younger" brains compared with those who did not (F[1,27] = 12.3; P = 0.002). An "older" brain was significantly associated with decreased vibratory (r = 0.323; P = 0.033) and thermal (r = 0.345; P = 0.023) detection, deficient endogenous pain inhibition (F[1,25] = 4.6; P = 0.044), lower positive affect (r = -0.474; P = 0.005), a less agreeable (r = -0.439; P = 0.020), and less emotionally stable personality (r = -0.387; P = 0.042). Our findings suggest that chronic pain is associated with added "age-like" brain atrophy in relatively healthy, community-dwelling older individuals, and future studies are needed to determine the directionality of our findings. A brain aging biomarker may help identify people with chronic pain at a greater risk of functional decline and poorer health outcomes.
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Afecto/fisiología , Envejecimiento/fisiología , Encéfalo/fisiopatología , Dolor Crónico/fisiopatología , Personalidad/fisiología , Percepción del Tacto/fisiología , Anciano , Anciano de 80 o más Años , Atrofia/diagnóstico por imagen , Atrofia/fisiopatología , Atrofia/psicología , Biomarcadores , Encéfalo/diagnóstico por imagen , Dolor Crónico/diagnóstico por imagen , Dolor Crónico/psicología , Femenino , Calor , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Autoinforme , VibraciónRESUMEN
BACKGROUND: Hypertension is an established risk factor for dementia. However, it is unclear whether there are differential effects of angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blockers (ARB) on brain health. In human observational studies, the evidence for superiority of either agent remains unclear. OBJECTIVE: To compare brain atrophy and cognitive decline between people treated with ACEi or ARB. METHODS: Participants aged 55-90 years without dementia had brain magnetic resonance imaging and neuropsychological assessments performed at 3 time points. The sample was enriched with people with type 2 diabetes (T2D). Multivariable mixed models were used to examine longitudinal associations of antihypertensive medication class with change in cognition and total brain volume. RESULTS: Of 565 people with longitudinal data, there were 163 on ACEi (mean age 69.9 years, T2D:64% with) and 125 on ARB (mean age 69.6 years, T2D:62%) at baseline. The baseline characteristics of those taking either an ACEi or ARB were similar with regards to age, sex, blood pressure control, and vascular risk factors. The mean duration of follow up was 3.2 years. The baseline association of ACEi and ARB use with total brain volume was similar in both groups. However, those taking an ARB had a slower rate of brain atrophy than those taking an ACEi (pâ=â0.031). Neither ACEi nor ARB use was associated with baseline cognitive function or cognitive decline. CONCLUSIONS: These results support the theory that ARB may be preferable to ACEi to reduce brain atrophy. The mechanisms underlying this differential association warrant further investigation.
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Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Atrofia/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Hipertensión/tratamiento farmacológico , Anciano , Antihipertensivos/uso terapéutico , Atrofia/psicología , Disfunción Cognitiva/psicología , Progresión de la Enfermedad , Femenino , Humanos , Hipertensión/diagnóstico por imagen , Hipertensión/psicología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Estudios RetrospectivosRESUMEN
BACKGROUND: Visual rating scales are still the most popular tools in assessing atrophy degrees of whole brain and lobes. However, the false negative rate of the previous cutoff score of visual rating scales was relatively high for detecting dementia of Alzheimer's type (DAT). This study aimed to evaluate the diagnostic value of new cutoffs of visual rating scales on magnetic resonance imaging for discriminating DAT in a Chinese population. METHODS: Out of 585 enrolled subjects, 296 participants were included and diagnosed as normal cognition (NC)(n = 87), 138 diagnosed as amnestic mild cognitive impairment (aMCI), and 71 as dementia of Alzheimer's type (DAT). Receiver operating characteristic (ROC) curve analyses were used to calculate the diagnostic value of visual rating sales (including medial temporal atrophy (MTA), posterior atrophy rating scale (PA),global cortical atrophy scale (GCA) and medial temporal-lobe atrophy index (MTAi))for detecting NC from DAT . RESULTS: Scores of MTA correlated to age and Mini-mental state examination score. When used to detect DAT from NC, the MTA showed highest diagnostic value than other scales, and when the cutoff score of 1.5 of MTA scale, it obtained an optimal sensitivity (84.5%) and specificity (79.1%) respectively, with a 15.5% of false negative rate. Cutoff scores and diagnostic values were calculated stratified by age. For the age ranges 50-64, 65-74, 75-84 years, the following cut-offs of MTA should be used, ≥1.0(sensitivity and specificity were 92.3 and 68.4%), ≥1.5(sensitivity and specificity were 90.4 and 85.2%), ≥ 2.0(sensitivity and specificity were 70.8 and 82.3%) respectively. All of the scales showed relatively lower diagnostic values for discriminating aMCI from NC. CONCLUSIONS: The new age-based MTA cutoff showed better diagnostic accuracy for detecting DAT than previous standard, the list of practical cut-offs proposed here might be useful in clinical practice.
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Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/epidemiología , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/epidemiología , Imagen por Resonancia Magnética/normas , Lóbulo Temporal/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/psicología , Atrofia/diagnóstico por imagen , Atrofia/epidemiología , Atrofia/psicología , China/epidemiología , Disfunción Cognitiva/psicología , Estudios de Cohortes , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/diagnóstico por imagen , Enfermedades Neurodegenerativas/epidemiología , Enfermedades Neurodegenerativas/psicología , Estudios ProspectivosRESUMEN
Mechanisms implicated in the association between neurocysticercosis (NCC) and cognitive impairment remain unknown. Atahualpa residents aged ≥ 40 years with calcified NCC were identified as case patients and paired 1:1 to age- and gender-matched controls. The selection process generated 79 pairs. Cognitive performance was measured by the Montreal Cognitive Assessment (MoCA). A conditional logistic regression model revealed no differences in MoCA scores across case patients and controls, after adjusting for education, epilepsy, depression, and hippocampal atrophy. The single covariate remaining significant was hippocampal atrophy. When participants were stratified according to this covariate, linear models showed lower MoCA scores among case patients (but not controls) with hippocampal atrophy. In a fully adjusted linear regression model, age remained as the single covariate explaining cognitive impairment among NCC patients. This study demonstrates an association between hippocampal atrophy and poor cognitive performance among patients with calcified NCC, most likely attributable to the effect of age.
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Atrofia/diagnóstico , Calcinosis/diagnóstico , Disfunción Cognitiva/diagnóstico , Depresión/diagnóstico , Epilepsia/diagnóstico , Neurocisticercosis/diagnóstico , Factores de Edad , Anciano , Atrofia/complicaciones , Atrofia/psicología , Calcinosis/complicaciones , Calcinosis/psicología , Estudios de Casos y Controles , Cognición , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/psicología , Depresión/complicaciones , Depresión/psicología , Epilepsia/complicaciones , Epilepsia/psicología , Femenino , Hipocampo/patología , Hipocampo/fisiopatología , Humanos , Pruebas de Inteligencia , Modelos Lineales , Masculino , Persona de Mediana Edad , Neurocisticercosis/complicaciones , Neurocisticercosis/psicologíaRESUMEN
BACKGROUND: Imaging studies have revealed cortical thinning and subcortical atrophy occurring in Parkinson's disease (PD); however, the topographical distribution and clinical associations related to advancing stages of PD remains unclear. OBJECTIVE: We aimed to investigate the topographical distribution of cortical and subcortical morphometric changes, and their clinical associations, related to increasing disease severity. METHODS: In this cross-sectional imaging study, T1-weighted structural magnetic resonance imaging data for 80 non-demented PD patients and 30 age-matched healthy controls were analysed using FreeSurfer software suite to derive morphometric changes using whole-brain vertex-wise analysis, and surface-based (cortical) and volume-based (subcortical) parcellation maps. PD patients were divided into three groups of mild (nâ¯=â¯27), moderate (nâ¯=â¯27), and severe (nâ¯=â¯26) PD based disease duration and Hoehn and Yahr and Unified Parkinson's Disease Rating Scale Part-III motor severity scores. RESULTS: Whole-brain vertex-wise analysis revealed cortical thinning in the orbitofrontal cortex in early PD (Pâ¯=â¯.011), and in the superior frontal (Pâ¯=â¯.002), caudal middle frontal gyrus (Pâ¯=â¯.001) and inferior parietal cortex (Pâ¯=â¯.006) in moderate PD. Severe PD patients showed additional cortical thinning in temporal and occipital cortices (Pâ¯<â¯.005). Subcortical volume loss was detected in the thalamus (Pâ¯=â¯.012) and hippocampus (Pâ¯=â¯.032) in moderate PD, which extended to the caudate (Pâ¯=â¯.012), putamen (Pâ¯=â¯.042) and amygdala (Pâ¯=â¯.008) in severe PD. Increasing disease duration and motor severity scores, correlated with cortical thinning in frontal, temporal, parietal and occipital cortices, and subcortical volumetric loss in the thalamus, caudate, putamen, amygdala and hippocampus. Lower global cognitive status, measured with MMSE, correlated with cortical thinning in temporal, parietal, frontal and cingulate cortices, and with volumetric loss in the hippocampus (râ¯=â¯0.31; Pâ¯=â¯.009); suggesting subclinical pathogenic changes occur prior to the onset of cognitive impairment. CONCLUSION: In conclusion, in more severe disease stages PD patients exhibit progressive cortical thinning and subcortical volume loss which could have relevance to the development of cognitive impairment.
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Corteza Cerebral/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/psicología , Progresión de la Enfermedad , Enfermedad de Parkinson/diagnóstico por imagen , Enfermedad de Parkinson/psicología , Anciano , Atrofia/diagnóstico por imagen , Atrofia/psicología , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: Although multiple sclerosis (MS) has long been considered to primarily affect white matter, it is now recognized that cognitive deficits in MS are also related to neocortical, thalamic and hippocampal damage. However, the association between damage to these structures and memory deficits in MS is unclear. This study examines whether MS patients with cognitive impairment have a reduction of hippocampal and/or thalamic volumes compared to cognitively intact patients, and whether these volume reductions correlate with various aspects of memory function. METHODOLOGY: Volumetric MRI measures of thalamus and hippocampus of forty-one patients with MS were performed. The patients were divided in two groups depending on the presence or absence of cognitive impairment, based on their neuropsychological tests scores. RESULTS: Right hippocampal volume was found to be associated with learning, and the left thalamic volume was found to predict performance in verbal memory. Cognitively impaired patients had a tendency to have a reduced left thalamic volume compared to cognitively intact patients. CONCLUSIONS: This study does not support a direct relationship between hippocampal atrophy and verbal memory. These results add to the growing evidence of the involvement of thalamus in cognitive impairment in MS and its association with verbal memory deficits.
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Hipocampo/patología , Trastornos de la Memoria/patología , Memoria/fisiología , Esclerosis Múltiple/patología , Tálamo/patología , Adulto , Atrofia/diagnóstico por imagen , Atrofia/patología , Atrofia/psicología , Femenino , Hipocampo/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Trastornos de la Memoria/diagnóstico por imagen , Trastornos de la Memoria/psicología , Persona de Mediana Edad , Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/psicología , Pruebas Neuropsicológicas , Tamaño de los Órganos/fisiología , Tálamo/diagnóstico por imagenRESUMEN
Importance: Increased prevalence of language-based learning disabilities (LDs) has been previously reported in patients with primary progressive aphasia (PPA). This study hypothesized that patients with focal neurodegenerative syndromes outside the language network, such as posterior cortical atrophy (PCA), would have a higher rate of nonlanguage LDs, congruent with their mainly visuospatial presentation. Objective: To investigate the prevalence and type of LD (language and/or mathematical and visuospatial) in a large cohort of patients with PCA compared with patients with logopenic variant PPA (lvPPA) and amnestic Alzheimer disease (AD). Design, Setting, and Participants: This case-control study reviewed 279 medical records from a university-based clinic and research center for patients with neurodegenerative diseases for LD history, including patients with PCA (n = 95), patients with lvPPA (n = 84), and a matched cohort with amnestic AD (n = 100). No records were excluded. The study compared cognitive and neuroimaging features of patients with PCA with and without LDs. A review of the records of patients presenting from March 1, 1999, to August 31, 2014, revealed 95 PCA cases and 84 lvPPA cases. Then 100 patients with amnestic AD from this same period were chosen for comparison, matching against the groups for age, sex, and disease severity. Data analysis was performed from September 8, 2013, to November 6, 2017. Main Outcomes and Measures: Prevalence of total LD history and prevalence of language and mathematical or visuospatial LD history across all cohorts. Results: A total of 179 atypical AD cases (95 with PCA and 84 with lvPPA) and 100 disease control cases (amnestic AD) were included in the study. The groups were not statistically different for mean (SD) age at first visit (PCA, 61.9 [7.0] years; lvPPA, 65.1 [8.7] years; amnestic AD, 64.0 [12.6] years; P = .08), mean (SD) age at first symptom (PCA, 57.5 [7.0] years; lvPPA, 61.1 [9.0] years; amnestic AD, 59.6 [13.7] years; P = .06), or sex (PCA, 66.3% female; lvPPA, 56.0% female; amnestic AD, 57.0% female; P = .30) but differed on non-right-hand preference (PCA, 18.3%; lvPPA, 20.2%; amnestic AD, 7.7%; P = .04), race/ethnicity (PCA, 88.3% white; lvPPA, 99.0% white; amnestic AD, 80.0% white; P < .001), and mean (SD) educational level (PCA, 15.7 [3.2] years; lvPPA, 16.2 [3.3] years; amnestic AD, 14.8 [3.5] years; P = .02). A total of 18 of the 95 patients with PCA (18.9%) reported a history of LD, which is greater than the 3 of 100 patients (3.0%) in the amnestic AD cohort (P < .001) and the 10.0% expected rate in the general population (P = .007). In the PCA cohort, 13 of 95 patients (13.7%) had a nonlanguage mathematical and/or visuospatial LD; this rate was greater than that in the amnestic AD (1 of 100 [1.0%]; P < .001) and lvPPA (2 of 84 [2.4%]; P = .006) cohorts and greater than the 6.0% expected general population rate of mathematical LD (P = .003). Compared with the patients with PCA without LDs, the group with LDs had greater preservation of global cognition and a more right-lateralized pattern of atrophy. Conclusions and Relevance: Nonlanguage mathematical and visuospatial LDs were associated with focal, visuospatial predominant neurodegenerative clinical syndromes. This finding supports the hypothesis that neurodevelopmental differences in specific brain networks are associated with phenotypic manifestation of later-life neurodegenerative disease.
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Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/fisiología , Discapacidades para el Aprendizaje/diagnóstico por imagen , Matemática , Percepción Espacial/fisiología , Anciano , Atrofia/diagnóstico por imagen , Atrofia/psicología , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Discapacidades para el Aprendizaje/psicología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
In this review of the literature on posterior cortical atrophy (PCA), the history of the disease is first told through the studies of Frank Benson and Oliver Sacks. Then, we detail the possible underlying pathologies, Alzheimer's disease being the most common cause. Clinical, cognitive, and biological features are described, with a specific focus on the neuroimaging. We also describe the emotional aspects of PCA. These aspects are often overlooked, but deserve a particular attention due to their impact on the quality of life and prognostic implications for the patients. A multilevel care strategy for PCA patients is suggested.