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Insulin resistance increases the risk of incident Subcortical Small Vessel Type of Dementia 胰岛素抵抗增加发生皮质下小血管型痴呆的风险
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-12-14 DOI: 10.1016/j.cccb.2025.100440
Elin Axelsson Andrén , Petronella Kettunen , Anders Wallin , Johan Svensson

Introduction

Insulin resistance (IR) has been associated with cognitive decline and cortical vascular cognitive impairment. While IR has been linked to white matter abnormalities in population-based studies, few studies have examined the impact of IR in a clinical population.
The aim was to investigate the association between baseline Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and the risk of progression to the subcortical small vessel type of dementia (SSVD) or Alzheimer's disease (AD) in a memory clinic cohort.

Methods

A total of 352 patients with subjective cognitive impairment (SCI) or mild cognitive impairment (MCI) were followed for up to six years (mean follow-up: 4.1 years). Cox proportional hazards regression models were used to assess the association between baseline HOMA-IR and the risk of SSVD or AD with adjustment for relevant covariates.

Results

During the follow-up, 24% (n=83) of the SCI/MCI patients converted to dementia (SSVD, n = 28; AD, n = 55). Higher HOMA-IR levels were significantly associated with increased risk of progression to SSVD (adjusted hazard ratio [HR] = 1.42, 95% CI: 1.17–1.73, p < 0.001), but not with the risk of AD. Patients in the highest HOMA-IR quintile (Q5) had a markedly elevated risk of SSVD compared to those in the lowest quintile, Q1 (adjusted HR = 6.60, 95% CI: 1.02 – 42.54, p < 0.05). No significant association was observed between HOMA-IR and the risk of AD.

Conclusions

Insulin resistance is an independent predictor of conversion to SSVD, but not of the risk of AD, among patients with SCI or MCI. These findings highlight the potential role of metabolic dysfunction in the pathogenesis of SSVD and suggest that HOMA-IR could be useful both in the identification and prevention of progression to SSVD in a memory clinic population.
胰岛素抵抗(IR)与认知能力下降和皮质血管性认知障碍有关。虽然在基于人群的研究中,IR与白质异常有关,但很少有研究检查IR在临床人群中的影响。目的是在记忆临床队列中研究基线胰岛素抵抗稳态模型评估(HOMA-IR)与进展为皮质下小血管型痴呆(SSVD)或阿尔茨海默病(AD)的风险之间的关系。方法对352例主观认知障碍(SCI)或轻度认知障碍(MCI)患者进行为期6年的随访,平均随访4.1年。Cox比例风险回归模型用于评估基线HOMA-IR与SSVD或AD风险之间的关系,并校正相关协变量。结果随访期间,24% (n=83)的SCI/MCI患者转化为痴呆(SSVD, n = 28;AD, n = 55)。较高的HOMA-IR水平与SSVD进展的风险增加显著相关(调整后的风险比[HR] = 1.42,95% CI: 1.17-1.73, p < 0.001),但与AD的风险无关。HOMA-IR最高五分位数(Q5)的患者与最低五分位数(Q1)的患者相比,SSVD的风险显著升高(调整后风险比 = 6.60,95% CI: 1.02 - 42.54, p < 0.05)。未观察到HOMA-IR与AD风险之间的显著关联。结论:在SCI或MCI患者中,胰岛素抵抗是转化为SSVD的独立预测因子,但不是AD风险的预测因子。这些发现强调了代谢功能障碍在SSVD发病机制中的潜在作用,并提示HOMA-IR可能在记忆临床人群中识别和预防SSVD进展方面都是有用的。
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引用次数: 0
Utility of Psychological Tests in Non-demented Japanese CADASIL Patients 心理测试在日本非痴呆性CADASIL患者中的应用
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-12-14 DOI: 10.1016/j.cccb.2025.100459
Satoshi Saito, Chikage Kakuta, Hiroyuki Ishiyama, Tomotaka Tanaka, Masafumi Ihara

Introduction

Previous studies have reported the usefulness of the Montreal Cognitive Assessment (MoCA) and other psychological tests, primarily in Caucasian patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). In this study, we evaluated the effectiveness of psychological tests in detecting mild cognitive impairment in Japanese patients with CADASIL, including those with the pro-hemorrhagic subtype associated with the NOTCH3 p.R75P variant.

Methods

In this single-center prospective study, we examined the utility of the MoCA, Mini-Mental State Examination (MMSE), Trail Making Test (TMT), and the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Dementia patients (Clinical dementia rating [CDR]≧1) were excluded. Receiver operating characteristic curves were calculated to examine the sensitivity and specificity of clinical cutoffs for the detection of mild cognitive impairment (CDR=0.5).

Results

Out of the 61 CADASIL patients who gave written informed consent and visited our clinic between January and December 2022, 51 were included in this study, and 10 were excluded due to CDR≧1. The mean age (standard deviation) was 54 (8), and 28 (55%) were male. The most common mutation was the p.R75P variant, found in 11 patients (22%). Based on the CDR scores, we classified the 51 CADASIL patients into 19 with mild cognitive impairment and 32 without. The ROC analysis showed an area under the curve of 0.90 for MoCA, 0.72 for MMSE, 0.81 and 0.86 for TMT-A and B, and 0.77 and 0.73 for WAIS- IV Digit Span and Digit Symbol. The optimal cut-off values for MMSE and MoCA were 27/28 (sensitivity, 0.58; specificity, 0.84) and 24/25 (sensitivity, 0.74; specificity, 0.97), respectively.

Conclusions

The MoCA and TMT were found to be sensitive screening tools for detecting mild cognitive impairment in Japanese patients with CADASIL.
先前的研究报道了蒙特利尔认知评估(MoCA)和其他心理测试的有效性,主要用于患有大脑常染色体显性动脉病变伴皮层下梗死和白质脑病(CADASIL)的高加索患者。在这项研究中,我们评估了心理测试在检测日本CADASIL患者轻度认知障碍方面的有效性,包括与NOTCH3 p.R75P变异相关的前出血性亚型患者。方法在这项单中心前瞻性研究中,我们检查了MoCA,迷你精神状态检查(MMSE),轨迹测验(TMT)和韦氏成人智力量表-第四版(WAIS-IV)的效用。排除痴呆患者(临床痴呆评分≧1)。计算受试者工作特征曲线,以检验检测轻度认知障碍(CDR=0.5)的临床临界值的敏感性和特异性。结果在2022年1月至12月期间给予书面知情同意并就诊的61例CADASIL患者中,51例纳入本研究,10例因CDR≧1而被排除。平均年龄(标准差)为54岁(8岁),男性28例(55%)。最常见的突变是p.R75P变异,在11例患者中发现(22%)。根据CDR评分,我们将51例CADASIL患者分为轻度认知障碍19例和无认知障碍32例。ROC分析显示,MoCA的曲线下面积为0.90,MMSE的曲线下面积为0.72,TMT-A和B的曲线下面积为0.81和0.86,WAIS- IV数字跨度和数字符号的曲线下面积为0.77和0.73。MMSE和MoCA的最佳临界值分别为27/28(敏感性0.58,特异性0.84)和24/25(敏感性0.74,特异性0.97)。结论MoCA和TMT是检测日本CADASIL患者轻度认知功能障碍的灵敏筛查工具。
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引用次数: 0
Increased levels of Chitinase-3-like protein 1 in blood is associated with increased Matrix Metaloproteinase-10 and reduced cognition in an amnestic MCI cohort 遗忘型轻度认知损伤患者血液中几丁质酶-3样蛋白1水平升高与基质金属蛋白酶-10升高和认知能力下降相关
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-12-14 DOI: 10.1016/j.cccb.2025.100410
Jiaqi Liu , Sofia Michopoulou , Jessica L. Teeling

Introduction

Altered blood-brain barrier (BBB) function can influence Alzheimer’s Disease (AD) progression. Chitinase-3-like protein 1 (Chi3l1/YKL-40) has been suggested as a potential AD fluid biomarker to predict disease progression and is increased in CSF/blood from patients diagnosed with MCI and AD. In AD, Matrix Metaloproteinase-10 (MMP-10) levels in the cerebrospinal fluid (CSF) are also increased in AD compared to healthy controls, with higher level being related to more vulnerable BBB. The sampling of CSF is invasive, and blood samples can be more widely used. Compared with CSF, there are relatively limited studies focus on AD diagnostic potential of YKL-40 and MMP-10 in serum. Here we evaluate if levels of YKL-40 and MMP-10 in blood samples is associated with cognitive decline in a human dementia cohort.

Methods

Serum samples from 102 participants, including 44 healthy controls and 58 patients with amnestic mild cognitive impairment (aMCI) in the ICOS study were analysed (Sussams et al., 2020). Participants were monitored for cognitive function (MoCA) at six- monthly intervals over 18 months and a follow up at 5 years. Blood samples obtained at 12 months post recruitment were analysed in this study. The levels of MMP-10 and YKL-40 were measured using Mesoscale platform. Correlation analysis was used to evaluate if these markers are associated with cognitive function. For comparison, brain sections from 11 months old wild-type mice and APP/PS1 transgenic mice were analysed for expression levels of YKL-40 in association with the cerebral vasculature (CD31).

Results

YKL-40 showed a significant correlation between decreasing MoCA cognitive test scores (Rho=-0.319, p=0.004) and increasing concentration of MMP-10 (Rho=0.325, p=0.004). MMP-10 showed a weak but statistically significant increase with decreasing MoCA scores (Rho=-0.211, p=0.036). Immunofluorescence staining showed co-localization of YKL-40 and CD31 in both WT and APP/PS1 mouse brain.

Conclusions

In this study, blood levels of YKL-40 and MMP-10 were significantly associated with cognitive impairment, they are also positively associated with each other, suggesting YKL-40 might relate to BBB integrity. Mouse study confirmed the YKL-40 expression in association with endothelial cells, evidenced by the colocalization of YKL-40 with endothelial cell marker CD31. The relationship between YKL-40 and BBB integrity requires further research.
血脑屏障(BBB)功能改变可影响阿尔茨海默病(AD)的进展。几丁质酶-3样蛋白1 (Chi3l1/YKL-40)被认为是预测疾病进展的潜在AD液体生物标志物,并且在诊断为MCI和AD的患者的CSF/血液中升高。在阿尔茨海默病患者中,脑脊液(CSF)中基质金属蛋白酶-10 (MMP-10)水平也比健康对照组升高,且水平升高与更脆弱的血脑屏障有关。脑脊液的采样是有创的,血液样本可以更广泛地使用。与脑脊液相比,血清中YKL-40和MMP-10对AD的诊断潜力研究相对有限。在这里,我们评估血液样本中YKL-40和MMP-10的水平是否与人类痴呆队列的认知能力下降有关。方法分析来自102名参与者的血清样本,包括44名健康对照和58名健忘轻度认知障碍(aMCI)患者的ICOS研究(Sussams et al., 2020)。参与者在18个月内每隔6个月监测一次认知功能(MoCA),并随访5年。本研究分析了招募后12个月获得的血液样本。采用中尺度平台测定MMP-10和YKL-40水平。使用相关性分析来评估这些标记是否与认知功能相关。为了进行比较,我们分析了11月龄野生型小鼠和APP/PS1转基因小鼠的脑切片,以检测与脑血管系统相关的YKL-40 (CD31)的表达水平。结果sykl -40与MoCA认知测试分数降低(Rho=-0.319, p=0.004)与MMP-10浓度升高(Rho=0.325, p=0.004)呈显著相关。MMP-10随MoCA评分的降低呈微弱但有统计学意义的升高(Rho=-0.211, p=0.036)。免疫荧光染色显示YKL-40和CD31在WT和APP/PS1小鼠脑内共定位。结论本研究中,血中YKL-40和MMP-10水平与认知功能障碍显著相关,且两者呈正相关,提示YKL-40可能与血脑屏障完整性有关。小鼠研究证实了YKL-40的表达与内皮细胞有关,YKL-40与内皮细胞标志物CD31共定位。YKL-40与血脑屏障完整性的关系有待进一步研究。
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引用次数: 0
On the origin of cerebral small vessel disease: MRI markers of cSVD in young adults with hypertension 关于脑血管疾病的起源:年轻成人高血压患者cSVD的MRI标志物
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-09-20 DOI: 10.1016/j.cccb.2025.100397
M.H. Snijders , E. Janssen , E. Verburgt , A. ter Telgte , T.N.A. van den Berg , M.C. Maas , F.J.A. Meijer , A.M. Tuladhar , N.P. Riksen , J. Deinum , F.E. de Leeuw

Introduction

Cerebral small vessel disease (cSVD) contributes to stroke and cognitive decline, with MRI markers of cSVD increasing with age. Hypertension is an important risk factor for cSVD in older adults but its impact in younger individuals remains less clear. This study investigates whether MRI markers of cSVD are more prevalent in young hypertensive individuals compared to normotensive controls.

Methods

In this cross-sectional study, 60 patients with hypertension and 21 controls aged 18–55 years underwent 3T MRI to assess cSVD markers: white matter hyperintensities (WMH), lacunes, and microbleeds. Group differences were assessed using t-tests, chi-square tests, or non-parametric methods. We examined associations between blood pressure and cSVD markers using multivariable regression models, including linear, logistic, ordinal logistic, and penalized logistic regression, adjusting for potential confounders.

Results

Patients with hypertension were older (median (IQR) 35.6 (29.6–41.4) years vs 29.2 (27.8–33.2) years), had a higher BMI, and lower education levels while proportion of females was similar. Deep WMH burden was significantly higher in hypertensive participants (median Fazekas score: 1 [IQR: 0–1] vs 0 [IQR: 0–0]; p < 0.001). Hypertension increased odds of deep WMH (OR 5.49, p = 0.011). Lacunes and microbleeds were rare and observed only in hypertensive participants. Duration since hypertension diagnosis was not significantly associated with WMH volume (β=7.27, p = 0.111) after adjusting for age.

Conclusion

WMH are more prevalent in young adults with hypertension, suggesting early microvascular brain changes. These findings underscore the importance of early detection and treatment of hypertension to potentially prevent long-term cerebrovascular changes.
脑血管病(cSVD)与脑卒中和认知能力下降有关,cSVD的MRI标志物随着年龄的增长而增加。高血压是老年人心血管疾病的重要危险因素,但其对年轻人的影响尚不清楚。本研究探讨了与血压正常的对照组相比,年轻高血压患者中心血管疾病的MRI标志物是否更为普遍。方法在这项横断面研究中,60例高血压患者和21例年龄在18-55岁的对照组接受了3T MRI检查,以评估心血管疾病标志物:白质高强度(WMH)、腔隙和微出血。采用t检验、卡方检验或非参数方法评估组间差异。我们使用多变量回归模型,包括线性、逻辑、有序逻辑和惩罚逻辑回归,对潜在的混杂因素进行调整,研究了血压和cSVD标志物之间的关系。结果高血压患者年龄较大(IQR中位数为35.6(29.6-41.4)岁vs 29.2(27.8-33.2)岁),BMI较高,文化程度较低,女性比例相近。高血压参与者的深度WMH负担显著更高(Fazekas评分中位数:1 [IQR: 0 - 1] vs 0 [IQR: 0 - 0]; p < 0.001)。高血压增加深部WMH的发生率(OR 5.49, p = 0.011)。腔隙和微出血是罕见的,仅在高血压参与者中观察到。调整年龄后,高血压诊断后的持续时间与WMH体积无显著相关性(β=7.27, p = 0.111)。结论青壮年高血压患者多发wmh,提示早期脑微血管改变。这些发现强调了早期发现和治疗高血压对于潜在地预防长期脑血管改变的重要性。
{"title":"On the origin of cerebral small vessel disease: MRI markers of cSVD in young adults with hypertension","authors":"M.H. Snijders ,&nbsp;E. Janssen ,&nbsp;E. Verburgt ,&nbsp;A. ter Telgte ,&nbsp;T.N.A. van den Berg ,&nbsp;M.C. Maas ,&nbsp;F.J.A. Meijer ,&nbsp;A.M. Tuladhar ,&nbsp;N.P. Riksen ,&nbsp;J. Deinum ,&nbsp;F.E. de Leeuw","doi":"10.1016/j.cccb.2025.100397","DOIUrl":"10.1016/j.cccb.2025.100397","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebral small vessel disease (cSVD) contributes to stroke and cognitive decline, with MRI markers of cSVD increasing with age. Hypertension is an important risk factor for cSVD in older adults but its impact in younger individuals remains less clear. This study investigates whether MRI markers of cSVD are more prevalent in young hypertensive individuals compared to normotensive controls.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, 60 patients with hypertension and 21 controls aged 18–55 years underwent 3T MRI to assess cSVD markers: white matter hyperintensities (WMH), lacunes, and microbleeds. Group differences were assessed using <em>t</em>-tests, chi-square tests, or non-parametric methods. We examined associations between blood pressure and cSVD markers using multivariable regression models, including linear, logistic, ordinal logistic, and penalized logistic regression, adjusting for potential confounders.</div></div><div><h3>Results</h3><div>Patients with hypertension were older (median (IQR) 35.6 (29.6–41.4) years vs 29.2 (27.8–33.2) years), had a higher BMI, and lower education levels while proportion of females was similar. Deep WMH burden was significantly higher in hypertensive participants (median Fazekas score: 1 [IQR: 0–1] vs 0 [IQR: 0–0]; <em>p</em> &lt; 0.001). Hypertension increased odds of deep WMH (OR 5.49, <em>p</em> = 0.011). Lacunes and microbleeds were rare and observed only in hypertensive participants. Duration since hypertension diagnosis was not significantly associated with WMH volume (β=7.27, <em>p</em> = 0.111) after adjusting for age.</div></div><div><h3>Conclusion</h3><div>WMH are more prevalent in young adults with hypertension, suggesting early microvascular brain changes. These findings underscore the importance of early detection and treatment of hypertension to potentially prevent long-term cerebrovascular changes.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"9 ","pages":"Article 100397"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advantages and challenges of using arterial spin labelling MRI to monitor cerebral blood flow in multi-centre clinical trials of neurodegenerative disease: Comment 在神经退行性疾病的多中心临床试验中,使用动脉自旋标记MRI监测脑血流的优势和挑战:评论
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-03-18 DOI: 10.1016/j.cccb.2025.100382
Hinpetch Daungsupawong , Viroj Wiwanitkit
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引用次数: 0
Cerebral small vessel disease lesion segmentation methods: A systematic review 脑血管疾病病灶分割方法的系统综述
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-09-19 DOI: 10.1016/j.cccb.2025.100396
Jolene Phelps , Manpreet Singh , Cheryl R. McCreary , Caroline Dallaire-Théroux , Ryan G. Stein , Zacharie Potvin-Jutras , Dylan X. Guan , Jeng-liang D. Wu , Amelie Metz , Eric E. Smith
Cerebral small vessel disease (CSVD) can manifest as brain lesions visible on magnetic resonance imaging, including white matter hyperintensities (WMH), cerebral microbleeds (CMB), perivascular spaces (PVS), lacunes, and recent small subcortical infarcts (RSSI). Detection and segmentation of these imaging markers can provide valuable information on brain health, including prevention and treatment of dementia. However, manual segmentation is cumbersome, especially for large cohorts in research studies. There has been extensive research into the development of automated tools using machine learning to increase accuracy and efficiency in lesion segmentation. This systematic review aimed to summarize novel automated methods developed over the last 10 years that segment CSVD lesion types and have been validated on a population with or at risk for CSVD (e.g., older adults, those with cognitive disorders, or those with vascular risk factors). A search on Web of Science and PubMed yielded 2764 studies, of which 89 were included after screening and full text review. 59 of these methods segmented WMH, 23 detected or classified CMB, 6 detected or segmented PVS, 5 detected, classified, or segmented lacunes, and 2 segmented RSSI. Of these, 30 studies (23 for WMH, 5 for CMB, 1 for PVS, and 1 for lacunes) included links to download code or pre-trained models, including one commercial tool, and one that relied on a commercial tool for input. Overall, this review found good evidence for high quality tools available for WMH segmentation, with fewer tools available to accurately segment other CSVD lesion types.
脑小血管疾病(CSVD)可表现为磁共振成像上可见的脑病变,包括白质高信号(WMH)、脑微出血(CMB)、血管周围间隙(PVS)、腔隙和近期皮质下小梗死(RSSI)。检测和分割这些成像标记可以提供有关大脑健康的宝贵信息,包括预防和治疗痴呆症。然而,人工分割是很麻烦的,特别是对于研究中的大型队列。人们对使用机器学习的自动化工具的开发进行了广泛的研究,以提高病变分割的准确性和效率。本系统综述旨在总结过去10年来开发的新的自动化方法,这些方法用于分割CSVD病变类型,并已在CSVD患者或高危人群(例如,老年人、认知障碍患者或有血管危险因素的人群)中得到验证。在Web of Science和PubMed上搜索得到2764项研究,其中89项是经过筛选和全文审查后纳入的。其中59种方法对WMH进行了分割,23种方法对CMB进行了检测或分类,6种方法对PVS进行了检测或分割,5种方法对lacunes进行了检测、分类或分割,2种方法对RSSI进行了分割。在这些研究中,有30项研究(23项关于WMH, 5项关于CMB, 1项关于pv, 1项关于lacunes)包括下载代码或预训练模型的链接,其中包括一个商业工具,以及一个依赖于商业工具输入的模型。总的来说,本综述发现了用于WMH分割的高质量工具的良好证据,而用于准确分割其他CSVD病变类型的工具较少。
{"title":"Cerebral small vessel disease lesion segmentation methods: A systematic review","authors":"Jolene Phelps ,&nbsp;Manpreet Singh ,&nbsp;Cheryl R. McCreary ,&nbsp;Caroline Dallaire-Théroux ,&nbsp;Ryan G. Stein ,&nbsp;Zacharie Potvin-Jutras ,&nbsp;Dylan X. Guan ,&nbsp;Jeng-liang D. Wu ,&nbsp;Amelie Metz ,&nbsp;Eric E. Smith","doi":"10.1016/j.cccb.2025.100396","DOIUrl":"10.1016/j.cccb.2025.100396","url":null,"abstract":"<div><div>Cerebral small vessel disease (CSVD) can manifest as brain lesions visible on magnetic resonance imaging, including white matter hyperintensities (WMH), cerebral microbleeds (CMB), perivascular spaces (PVS), lacunes, and recent small subcortical infarcts (RSSI). Detection and segmentation of these imaging markers can provide valuable information on brain health, including prevention and treatment of dementia. However, manual segmentation is cumbersome, especially for large cohorts in research studies. There has been extensive research into the development of automated tools using machine learning to increase accuracy and efficiency in lesion segmentation. This systematic review aimed to summarize novel automated methods developed over the last 10 years that segment CSVD lesion types and have been validated on a population with or at risk for CSVD (<em>e.g.,</em> older adults, those with cognitive disorders, or those with vascular risk factors). A search on Web of Science and PubMed yielded 2764 studies, of which 89 were included after screening and full text review. 59 of these methods segmented WMH, 23 detected or classified CMB, 6 detected or segmented PVS, 5 detected, classified, or segmented lacunes, and 2 segmented RSSI. Of these, 30 studies (23 for WMH, 5 for CMB, 1 for PVS, and 1 for lacunes) included links to download code or pre-trained models, including one commercial tool, and one that relied on a commercial tool for input. Overall, this review found good evidence for high quality tools available for WMH segmentation, with fewer tools available to accurately segment other CSVD lesion types.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"9 ","pages":"Article 100396"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Variation in vascular risk assessment and management across UK memory/brain health clinics: a cross-sectional survey 英国记忆/脑健康诊所血管风险评估和管理的差异:一项横断面调查
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-12-14 DOI: 10.1016/j.cccb.2025.100476
Ross A. Dunne , Lieza Exalto , Simon Young , Atticus Hainsworth , Vanessa Raymont

Introduction

Vascular risk factors (VRFs) are major, actionable contributors to cognitive dysfunction across the spectrum from vascular cognitive impairment (VCI) to mixed pathologies. Reflecting this, international and UK guidance recommend systematic identification and treatment of VRFs as part of routine care—providing clear levers for memory/brain health services to integrate risk assessment, lifestyle support and pharmacotherapy. **Objective:** To characterise current UK brain health/memory clinic practice in VRF assessment, documentation and downstream management, to inform standardisation of a pragmatic “minimum VRF dataset” and facilitate better data collection under circumstances of increased workload across health services.

Methods

We conducted a cross-sectional questionnaire of UK clinics routinely assessing cognition.Descriptive statistics are reported. Clinics were approached through the Dementia Platforms UK mailing list and members of the UK Brain Health Coalition were also contacted.

Results

Six clinics (mean 222, median 250 new referrals/year) responded to the first wave questionnaire. Overall they estimated that a mean 20.8% (range 5–50%) of referrals had pure or mixed VCI features. Five of six clinics (83%) reported routine VRF assessment for all new patients. Commonly assessed VRFs were diabetes/HbA1c, dyslipidaemia, smoking status, prior stroke/TIA, physical activity, and alcohol use (each 5/6, 83%); blood pressure, BMI/obesity, and sleep apnoea were assessed by 4/6 (67%); pulse-wave velocity and atrial fibrillation by 2/6 (33%); carotid stenosis and peripheral vascular disease by 1/6 (17%). Direct interventions provided within clinics included antihypertensives (3/6), statins (2/6), antiplatelets (2/6), and anticoagulants (1/6). VRFs were documented “always/usually” in 5/6 services. Only 2/6 reported staff training in VRF assessment within the past two years; 2/6 audited VRF assessment rates (with a further 1/6 planning to). Top barriers were time constraints (5/6), unclear guidelines (4/6), and equipment/resources (3/6). Facilitators most often cited were additional staff training (4/6), clear protocols/pathways (3/6), better IT integration (3/6), and administrative support (3/6).

Conclusions

UK memory / brain health clinics view VRF assessment as essential, but practice remains heterogeneous, with limited training and audit. Standardising a minimum VRF dataset and embedding clear referral/treatment pathways—supported by training, IT templates, and admin capacity—may improve consistency and impact.
从血管性认知障碍(VCI)到混合病理,血管危险因素(vrf)是认知功能障碍的主要、可操作的因素。有鉴于此,国际和英国的指南建议系统地识别和治疗vrf,将其作为常规护理的一部分,为记忆/大脑健康服务提供明确的杠杆,以整合风险评估、生活方式支持和药物治疗。**目的:**描述当前英国脑健康/记忆诊所在VRF评估、记录和下游管理方面的实践,为实用的“最小VRF数据集”的标准化提供信息,并在卫生服务工作量增加的情况下促进更好的数据收集。方法:我们对英国诊所进行了一份评估认知能力的横断面问卷调查。报告了描述性统计数据。通过英国痴呆症平台的邮件列表联系了诊所,也联系了英国脑健康联盟的成员。结果6家诊所(平均222家,中位数250家/年)对第一波问卷有应答。总的来说,他们估计平均20.8%(范围5-50%)的转诊患者具有纯粹或混合的VCI特征。6家诊所中有5家(83%)报告了所有新患者的常规VRF评估。通常评估的vrf包括糖尿病/HbA1c、血脂异常、吸烟状况、既往卒中/TIA、身体活动和饮酒(各5/ 6,83 %);4/6(67%)评估血压、BMI/肥胖和睡眠呼吸暂停;脉搏波速度与房颤差2/6 (33%);颈动脉狭窄和周围血管疾病减少1/6(17%)。诊所提供的直接干预措施包括抗高血压(3/6)、他汀类药物(2/6)、抗血小板(2/6)和抗凝血药物(1/6)。vrf“总是/通常”记录在5/6个服务中。只有2/6报告在过去两年内对员工进行了VRF评估培训;2/6审核的VRF评估率(另有1/6计划)。最大的障碍是时间限制(5/6)、指导方针不明确(4/6)和设备/资源(3/6)。最常被提及的促进因素是额外的员工培训(4/6)、明确的协议/途径(3/6)、更好的IT集成(3/6)和行政支持(3/6)。suk记忆/脑健康诊所认为VRF评估是必要的,但实践仍然不一致,培训和审核有限。标准化最低VRF数据集并嵌入明确的转诊/治疗途径(由培训、IT模板和管理能力支持)可能会提高一致性和影响。
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引用次数: 0
Distinct Sodium Signatures in Vascular Dementia and Alzheimer’s Disease: A Potential Diagnostic Biomarker 血管性痴呆和阿尔茨海默病的不同钠特征:一种潜在的诊断生物标志物
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-12-14 DOI: 10.1016/j.cccb.2025.100496
Sasha Philbert , Jingshu Xu , Stephanie Church , Richard Unwin , Federico Roncaroli , Garth Cooper

Introduction

Vascular dementia (VaD) is the second most common cause of cognitive impairment amongst the elderly. However, there are no known disease-modifying therapies for VaD and an absence of effective clinical biomarkers that can accurately distinguish between VaD and Alzheimer’s disease (AD). A clinical marker of this nature would help future VaD clinical trials by helping ensure cohorts are comprised of VaD patients only, thus, leading to more efficient therapies. Metal dysregulation has been shown in several age-related dementias, with disease-specific patterns throughout the brain. Here, we investigated metal and protein levels in VaD to distinguish VaD from AD.

Methods

We employed inductively coupled plasma-mass spectrometry and liquid chromatography mass spectrometry to quantify the levels of essential metals and proteins in post-mortem VaD brain tissue (n = 10) and age-/sex-matched controls (n = 10) from seven brain regions. These data were compared with our data using the same methodology on AD patient samples. Proteomic data from the same VaD cases were used to identify possible sodium pathways.

Results

We observed elevated wet-weight cerebral sodium levels in VaD brain tissue in six of the seven regions analysed. Importantly, this widespread cerebral sodium elevation was not observed in AD, which instead showed a more localised elevation of sodium (3/7 brain regions, including the hippocampus, entorhinal cortex, and middle temporal gyrus). Corresponding proteomics on the same VaD tissue revealed protein expression changes, which map onto regions with elevated sodium.

Conclusions

These data imply widespread sodium dyshomeostasis in VaD brain tissue, which differs from AD, and may regulate – or be regulated by – specific protein expression changes. Furthermore, this cerebral sodium discrepancy between VaD and AD may have the potential as a diagnostic biomarker and help aid the clinical differentiation between VaD and AD.
血管性痴呆(VaD)是老年人认知障碍的第二大常见原因。然而,目前还没有已知的VaD疾病修饰疗法,也缺乏有效的临床生物标志物来准确区分VaD和阿尔茨海默病(AD)。这种性质的临床标志物将有助于未来的VaD临床试验,帮助确保队列仅由VaD患者组成,从而导致更有效的治疗。金属失调已在几种与年龄相关的痴呆症中得到证实,这种痴呆症在整个大脑中都有特定的疾病模式。在这里,我们研究了VaD中的金属和蛋白质水平,以区分VaD和AD。方法采用电感耦合等离子体质谱法和液相色谱体质谱法定量测定死后VaD脑组织(n = 10)和年龄/性别匹配对照(n = 10)7个脑区中必需金属和蛋白质的含量。这些数据与我们在AD患者样本中使用相同方法的数据进行了比较。来自相同VaD病例的蛋白质组学数据被用来确定可能的钠途径。结果在分析的7个区域中,我们观察到VaD脑组织中6个区域的脑钠湿重水平升高。重要的是,在阿尔茨海默病中没有观察到这种广泛的脑钠升高,相反,阿尔茨海默病显示出更局部的钠升高(3/7脑区,包括海马、内嗅皮层和颞中回)。在相同的VaD组织中,相应的蛋白质组学显示了蛋白质表达的变化,这些变化映射到钠含量升高的区域。结论与AD不同,VaD脑组织中存在广泛的钠代谢失调,并可能调节或受特异性蛋白表达变化的调节。此外,VaD和AD之间的脑钠差异可能具有作为诊断性生物标志物的潜力,有助于VaD和AD的临床区分。
{"title":"Distinct Sodium Signatures in Vascular Dementia and Alzheimer’s Disease: A Potential Diagnostic Biomarker","authors":"Sasha Philbert ,&nbsp;Jingshu Xu ,&nbsp;Stephanie Church ,&nbsp;Richard Unwin ,&nbsp;Federico Roncaroli ,&nbsp;Garth Cooper","doi":"10.1016/j.cccb.2025.100496","DOIUrl":"10.1016/j.cccb.2025.100496","url":null,"abstract":"<div><h3>Introduction</h3><div>Vascular dementia (VaD) is the second most common cause of cognitive impairment amongst the elderly. However, there are no known disease-modifying therapies for VaD and an absence of effective clinical biomarkers that can accurately distinguish between VaD and Alzheimer’s disease (AD). A clinical marker of this nature would help future VaD clinical trials by helping ensure cohorts are comprised of VaD patients only, thus, leading to more efficient therapies. Metal dysregulation has been shown in several age-related dementias, with disease-specific patterns throughout the brain. Here, we investigated metal and protein levels in VaD to distinguish VaD from AD.</div></div><div><h3>Methods</h3><div>We employed inductively coupled plasma-mass spectrometry and liquid chromatography mass spectrometry to quantify the levels of essential metals and proteins in post-mortem VaD brain tissue (n = 10) and age-/sex-matched controls (n = 10) from seven brain regions. These data were compared with our data using the same methodology on AD patient samples. Proteomic data from the same VaD cases were used to identify possible sodium pathways.</div></div><div><h3>Results</h3><div>We observed elevated wet-weight cerebral sodium levels in VaD brain tissue in six of the seven regions analysed. Importantly, this widespread cerebral sodium elevation was not observed in AD, which instead showed a more localised elevation of sodium (3/7 brain regions, including the hippocampus, entorhinal cortex, and middle temporal gyrus). Corresponding proteomics on the same VaD tissue revealed protein expression changes, which map onto regions with elevated sodium.</div></div><div><h3>Conclusions</h3><div>These data imply widespread sodium dyshomeostasis in VaD brain tissue, which differs from AD, and may regulate – or be regulated by – specific protein expression changes. Furthermore, this cerebral sodium discrepancy between VaD and AD may have the potential as a diagnostic biomarker and help aid the clinical differentiation between VaD and AD.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"9 ","pages":"Article 100496"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145796643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of in-vivo arteriolosclerosis with Brain Age Gap and vascular risk behaviors 体内小动脉硬化与脑年龄差距和血管危险行为的关系
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-12-14 DOI: 10.1016/j.cccb.2025.100470
Anna Marseglia , Caroline Dartora , Eric Westman , Konstantinos Arfanakis , Ana W Capuano

Introduction

Individuals age at different rates despite similar neuropathological burdens—some show accelerated cognitive decline, others preserve brain structure. Brain Age Gap (BAG) captures this variability in biological brain aging and has been linked to vascular risk behaviors and greater small vessel disease burden. ARTS is an in-vivo imaging marker of cerebral arteriolosclerosis, reflecting cumulative vascular risk exposure. Yet, to what extent ARTS influence BAG remains unclear. This study investigates the associations between BAG and ARTS, postmortem markers of athero-/arteriolosclerosis, vascular risk behaviors, and cognitive changes related to their interplay.

Methods

A total of 1,134 dementia-free individuals (mean age 79.0 ± 6.8) from four cohorts—ROS, MAP, MARS, LATC, Clinical Core of the Rush ADRC—with brain MRI were included in the study. Brain Age Gap (BAG) was computed as the difference between MRI- derived biological brain age (via deep learning) and chronological age. ARTS score was obtained from in-vivo MRI to assess arteriolosclerosis likelihood. Vascular risk behaviors (smoking, heart failure, hypertension, diabetes) were self-reported at baseline. Generalized linear models (GLM) were used, adjusting for age at MRI, sex, and education.

Results

Participants were 79 years of age at the MRI measure (SD=6.8), and 85% (n=966) were women. Greater ARTS score was associated with higher BAG, indicating older-appearing brains (β=2.79, SE 0.66, p<0.001). BAG was associated with smoking (β = 0.71, SE = 0.26, p = 0.007) and coronary heart failure (β = 0.97, SE = 0.54, p = 0.057). When ARTS was added, the association with coronary heart failure attenuated (β = 1.13, SE = 0.59, p = 0.074), while the link with smoking remained. No interaction between ARTS and sex was observed.

Conclusions

ARTS is linked to older-appearing brains, potentially reflecting the lasting imprint of vascular risk exposure. Our findings support BAG as a potential imaging marker of accelerated brain aging, spotlighting the influence of often modifiable vascular risk factors in shaping brain health. The cognitive consequences of this brain-vascular aging
尽管神经病理负担相似,但个体衰老的速度不同——一些人表现出加速的认知衰退,另一些人则保持大脑结构。脑年龄差距(BAG)捕获了生物脑衰老的这种变异性,并与血管危险行为和更大的小血管疾病负担有关。ARTS是脑小动脉硬化的体内成像标志物,反映了累积的血管风险暴露。然而,艺术对BAG的影响程度仍不清楚。本研究探讨了BAG和ARTS、动脉粥样硬化/小动脉硬化的死后标志物、血管危险行为以及与它们相互作用相关的认知变化之间的关系。方法从ros、MAP、MARS、LATC、Rush adrc临床核心4个队列共1134例无痴呆患者(平均年龄79.0±6.8岁)进行脑MRI研究。脑年龄差距(BAG)计算为MRI得出的生物脑年龄(通过深度学习)与实足年龄之间的差异。通过体内MRI获得ARTS评分以评估小动脉硬化的可能性。血管危险行为(吸烟、心力衰竭、高血压、糖尿病)在基线时自我报告。采用广义线性模型(GLM),调整MRI年龄、性别和教育程度。结果参与者在MRI测量时年龄为79岁(SD=6.8), 85% (n=966)为女性。更高的ARTS评分与更高的BAG相关,表明大脑看起来更老(β=2.79, SE 0.66, p<0.001)。包是与吸烟有关(β = 0.71 SE = 0.26,p = 0.007)和冠状动脉心脏衰竭(β = 0.97 SE = 0.54,p = 0.057)。当加入ARTS时,与冠状动脉心力衰竭的关联减弱(β = 1.13,SE = 0.59,p = 0.074),而与吸烟的关联仍然存在。没有观察到art与性之间的相互作用。结论sats与看起来更老的大脑有关,可能反映了血管风险暴露的持久印记。我们的研究结果支持BAG作为加速大脑衰老的潜在成像标记物,突出了通常可改变的血管危险因素在塑造大脑健康方面的影响。大脑血管老化的认知后果
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引用次数: 0
Investigating the role of neuroinflammation and microglia on cerebrovascular function in Alzheimer's disease 探讨神经炎症和小胶质细胞在阿尔茨海默病脑血管功能中的作用
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 Epub Date: 2025-12-14 DOI: 10.1016/j.cccb.2025.100482
Oliver Milner , Robbie Fisher , Daniel Asby , James Armstrong , Delphine Boche , Scott Miners

Introduction

Vessel-associated microglia (VAMs) have recently been identified as key regulators of cerebrovascular function implicated in blood-brain barrier (BBB) breakdown and impaired cerebral blood flow in Alzheimer’s disease (AD). We have explored the hypothesis that microglia migrate to the cerebral vasculature and exacerbate vascular damage associated with systemic infection and neuroinflammation.

Methods

We performed immunofluorescent labelling of FFPE sections from the superior temporal cortex of AD and control cases ± terminal systemic infection (N = 60). To characterise the density and phenotype of VAMs in each cohort, we immuno-labelled sections for CD31, CD68, Iba1 and HLA-DR. These measures were correlated with biochemical markers of cerebral perfusion, BBB integrity, and brain cytokine levels in corresponding frozen tissue from the same cases.
To explore microglial-cerebrovascular signalling, we exposed 3D co-cultures of HUVECs, pericytes, and microglia cultures to Aβ42 (1 uM), LPS (1 ug/mL) and Aβ42 and LPS in combination. Live cell imaging was used to assess microglial motility in response to vascular injury-conditioned media. Microarray analysis of the vascular co-culture media was conducted to identify signalling factors involved in microglial-cerebrovascular crosstalk.

Results

Immunofluorescence labelling showed an enrichment of Iba1+ve (p < 0.05) and HLA-DR+ve (p < 0.05) VAMs in AD. CD68 labelling revealed that VAMs were proportionally more phagocytic in AD alone (p < 0.05) and in the presence of systemic infection (p < 0.05). VAMs density was associated with markers of cerebral perfusion, BBB breakdown, and levels of brain cytokines. HMC3 microglia motility was increased upon exposure to HUVEC-pericyte media stimulated with AD-conditions. We will present data from the microarray to highlight specific signalling pathways influencing alterations in CAM motility.

Conclusions

We have shown that VAM density is increased in response to systemic infection and AD and is associated with neuroinflammation and markers of cerebral hypoperfusion and BBB breakdown. These studies provide further evidence that VAMs play an essential role in regulating cerebrovascular function in AD.
血管相关小胶质细胞(VAMs)最近被确定为涉及阿尔茨海默病(AD)血脑屏障(BBB)破坏和脑血流受损的脑血管功能的关键调节因子。我们已经探索了小胶质细胞迁移到脑血管系统并加剧与全身感染和神经炎症相关的血管损伤的假设。方法对阿尔茨海默病(AD)和对照患者±终末期全身性感染( = 60)的颞上皮层FFPE切片进行免疫荧光标记。为了表征每个队列中VAMs的密度和表型,我们对CD31、CD68、Iba1和HLA-DR切片进行了免疫标记。这些指标与来自同一病例的相应冷冻组织的脑灌注、血脑屏障完整性和脑细胞因子水平的生化指标相关。为了探索小胶质-脑血管信号,我们将huvec、周细胞和小胶质细胞3D共培养物暴露于a - β42 (1 μ m)、LPS (1 μ g/mL)以及a - β42和LPS联合作用下。活细胞成像用于评估小胶质细胞对血管损伤条件介质的反应。对血管共培养培养基进行了微阵列分析,以确定参与小胶质-脑血管串扰的信号因子。结果免疫荧光标记显示AD组织中Iba1+ve (p < 0.05)和HLA-DR+ve (p < 0.05) VAMs富集。CD68标记显示,在单独AD时(p < 0.05)和存在全身感染时(p < 0.05), VAMs的吞噬能力比例更高。VAMs密度与脑灌注、血脑屏障破坏和脑细胞因子水平相关。暴露于受ad条件刺激的huvec -周细胞介质后,HMC3小胶质细胞的运动性增加。我们将展示来自微阵列的数据,以突出影响CAM运动改变的特定信号通路。结论:VAM密度在全身性感染和AD时升高,并与神经炎症、脑灌注不足和血脑屏障破坏标志物有关。这些研究进一步证明了VAMs在AD患者的脑血管功能调节中发挥重要作用。
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引用次数: 0
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Cerebral circulation - cognition and behavior
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