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Targeting biogenic amines to combat Alzheimer’s Disease 靶向生物胺对抗阿尔茨海默病
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100502
George Sideris-Lampretsas , Meiting Mai , David Attwell

Introduction

Reduction in cerebral blood flow (CBF) is the first clinically detectable symptom of Alzheimer’s Disease (AD) and is sufficient to cause cognitive decline, highlighting its therapeutic potential. To study this, we focus on how neuronal activity regulates local blood flow in the brain capillary network and how this is perturbed in AD (PMID: 31221773). Biogenic amines are well established modulators of CBF, and serotonin (5HT) specifically is inversely correlated with Aβ deposition (PMID: 21873225). Hence, our initial aim was to establish the molecular mechanism by which 5HT regulates flow in physiology, and explore whether this pathway is perturbed in AD.

Methods

To address this, we follow a preclinical approach combining experiments on in vitro acute brain slices, with in vivo two-photon brain imaging of anaesthetised mice. To study amyloidosis, we are using the AppNL-G-F mouse model of AD, in which APP with a humanized Aβ region containing three AD-related mutations is knocked in to avoid artefacts associated with APP overexpression.

Results

Our preliminary results suggest that in healthy animals, 5HT increases calcium in astrocytes through 5HT2CR which in turn leads to pericyte contraction though the release of vasoactive lipids. To our surprise, AD mice not only show changes in 5HT axon density, but most importantly develop markedly enlarged neuronal processes termed axonal spheroids, whose effect on cortical interstitial 5HT level and circuit functions remains unknown. Similar structures can also be observed in cholinergic, noradrenergic and dopaminergic neurons, which differ dramatically from axonal spheroids in glutamatergic axons, with far more axon swelling closer to the plaque.

Conclusions

Conceivably, the peri-plaque environment is strongly dictated by the type of affected axons, and the clinically used acetylcholinesterase and monoamine reuptake inhibitors restore peri-plaque neurotransmitter concentrations in the cortex. We are currently investigating how the presence of cholinergic and monoaminergic axonal spheroids affects local circuit activity, microglial responses and blood flow.
脑血流量减少(CBF)是阿尔茨海默病(AD)的第一个临床可检测的症状,足以导致认知能力下降,突出了其治疗潜力。为了研究这一点,我们将重点放在神经元活动如何调节脑毛细血管网络中的局部血流量以及AD中这是如何受到干扰的。生物胺是公认的CBF调节剂,血清素(5HT)与Aβ沉积呈负相关(pmiid: 21873225)。因此,我们最初的目的是建立5HT在生理上调节血流的分子机制,并探讨该途径是否在AD中受到干扰。为了解决这一问题,我们采用临床前方法,将体外急性脑切片实验与麻醉小鼠的体内双光子脑成像相结合。为了研究淀粉样变性,我们使用了AD小鼠AppNL-G-F模型,在该模型中,APP具有人源化的a β区域,其中包含三个AD相关突变,以避免与APP过表达相关的伪像。结果我们的初步结果表明,在健康动物中,5HT通过5HT2CR增加星形胶质细胞中的钙,进而通过释放血管活性脂质导致周细胞收缩。令我们惊讶的是,AD小鼠不仅表现出5HT轴突密度的变化,而且最重要的是,轴突球体显著增大,其对皮层间质5HT水平和回路功能的影响尚不清楚。在胆碱能、去甲肾上腺素能和多巴胺能神经元中也可以观察到类似的结构,它们与谷氨酸能轴突的轴突球体显著不同,轴突在靠近斑块的地方肿胀得更多。可以想象,斑块周围环境在很大程度上取决于受影响轴突的类型,临床使用的乙酰胆碱酯酶和单胺再摄取抑制剂可恢复斑块周围皮层的神经递质浓度。我们目前正在研究胆碱能和单胺能轴突球体的存在如何影响局部回路活动、小胶质反应和血流。
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引用次数: 0
Inflammatory driven remodelling of the brain endothelial glycocalyx 炎症驱动的脑内皮糖萼重塑
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100499
Anna L Gray, Ingo Schiessl, Adam Greenstein

Introduction

Leukocyte migration is central to our ability to fight infection. One critical component of the leukocyte recruitment cascade that has been overlooked is the endothelial glycocalyx, composed of a complex network of proteoglycans, glycoproteins, and glycosaminoglycans (GAGs). The glycocalyx lines the luminal surface of blood vessels and in a healthy context precludes interactions between circulating leukocytes and the endothelium. In conditions such as small vessel disease and post-ischemic stroke, leukocyte recruitment into the brain can be excessive and contributes to pathology. The glycocalyx is thought to be remodelled during inflammation to enable leukocyte:endothelial cell interaction, however the details of this process remain unclear. We hypothesise that these modifications contribute significantly to disease mechanisms, driving transendothelial migration of immune cells.

Methods

We have established a system to effectively analyse glycocalyx composition and vascular permeability, and to monitor changes in response to inflammatory mediators.

Results

We demonstrate that glycocalyx composition differs between vessel types, and comparisons between brain and peripheral vasculature reveal context-dependent variability. These findings suggest that targeted modulation of specific glycocalyx components may be required in a disease-specific manner. Inflammatory challenge significantly increases both vascular permeability and leukocyte adhesion. Additionally, photothrombotic stroke induces substantial disruption of the endothelial glycocalyx and enhances leukocyte recruitment. We have developed an IMARIS image analysis pipeline to quantify glycocalyx thickness.

Conclusions

Here we build on the limited knowledge of glycocalyx structure and composition in vivo. We present a reliable technique using chronic cranial window implantation and high resolution intravital imaging, to examine the glycocalyx. This research represents an under-studied biological challenge, with therapeutic significance to a multitude of diseases.
白细胞的迁移对我们抵抗感染的能力至关重要。一个被忽视的白细胞招募级联的关键组成部分是内皮糖萼,它由蛋白聚糖、糖蛋白和糖胺聚糖(GAGs)的复杂网络组成。糖萼排列在血管的管腔表面,在健康的情况下阻止循环白细胞和内皮细胞之间的相互作用。在小血管疾病和缺血性中风等情况下,白细胞进入大脑可能过多,并导致病理。糖萼被认为在炎症期间被重塑以使白细胞与内皮细胞相互作用,然而这一过程的细节尚不清楚。我们假设这些修饰对疾病机制有重要贡献,驱动免疫细胞的跨内皮迁移。方法建立糖萼组成和血管通透性分析系统,监测糖萼对炎症介质的反应变化。结果我们证明糖萼组成在不同的血管类型之间是不同的,脑和外周血管之间的比较揭示了上下文相关的变异性。这些发现表明,特定糖萼成分的靶向调节可能需要以疾病特异性的方式进行。炎症刺激显著增加血管通透性和白细胞粘附。此外,光血栓性中风引起内皮糖萼的严重破坏,并增强白细胞的募集。我们开发了一个IMARIS图像分析管道来量化糖萼的厚度。结论本研究建立在对体内糖萼结构和组成的有限认识基础上。我们提出了一种可靠的技术,使用慢性颅窗植入和高分辨率活体成像来检查糖萼。这项研究代表了一个尚未充分研究的生物学挑战,对多种疾病具有治疗意义。
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引用次数: 0
Higher cardiovascular risk measured with SCORE2-OP is associated with lower global cognitive level in older adults 用SCORE2-OP测量的心血管风险较高与老年人整体认知水平较低相关
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100449
Malva Hillman, Johan Skoog, Lina Rydén, Ingmar Skoog

Introduction

Several cardiovascular risk factors, including hypertension and smoking, are also risk factors for dementia. Cardiovascular risk can be measured with different risk scores, like the Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP), which estimates the 10-year percentual risk of fatal or nonfatal cardiovascular events in individuals over the age of 70. This project aims to study whether higher SCORE2-OP is associated with worse cognitive performance.

Methods

Participants were drawn from the Gothenburg H70 Birth Cohort Studies (n=1263), aged 70 years at baseline and 75–78 at follow-up. SCORE2-OP was calculated based on geographical risk region, age, sex, diabetes, current smoking, systolic blood pressure, and total and HDL cholesterol, at baseline. Cognitive performance was measured through a cognitive test battery at baseline and follow-up. Z-scores were calculated for ten cognitive tests; the tests were divided into five cognitive domains and averaged to yield a domain score. Finally, the domain scores were averaged to provide a global cognitive score. Linear mixed-effect analyses were conducted wherein by-subject intercept (random effect) and fixed effects (SCORE2-OP, Swedish as first language, post-secondary education, and time-point) were evaluated in their ability to affect cognitive level and change. An interaction term between time and SCORE2-OP was tested in a separate model to study the association between SCORE2-OP and cognitive change. Sensitivity analyses were performed after excluding individuals with cardiovascular disease, dementia, or missing follow-up data.

Results

SCORE2-OP was associated with lower global cognitive level (β=-0.016, p≤.001), see Figure 1, but not cognitive decline (interaction term time*SCORE2-OP p =.163). The exclusion of individuals with cardiovascular disease, dementia, and no follow- up did not alter the results.

Conclusions

These findings suggest an association between higher cardiovascular risk, measured with SCORE2-OP, and lower global cognitive level but not decline. To further evaluate the relationship between SCORE2-OP and cognitive decline, cognitive performance should be assessed at more time-points with a longer follow-up. Future research should investigate whether associations vary across cognitive domains and to assess potential interactions between cardiovascular risk and neurodegenerative disorders. In summary, the findings indicate that cardiovascular health and cognition are connected, and treating cardiovascular risk factors could be helpful for cognitive health.
一些心血管危险因素,包括高血压和吸烟,也是痴呆的危险因素。心血管风险可以用不同的风险评分来衡量,比如系统性冠状动脉风险评估2-老年人(SCORE2-OP),它估计了70岁以上个体10年致命或非致命心血管事件的百分比风险。本项目旨在研究高SCORE2-OP是否与较差的认知表现相关。方法参与者来自哥德堡H70出生队列研究(n=1263),基线年龄为70岁,随访年龄为75-78岁。SCORE2-OP是根据基线时的地理危险区域、年龄、性别、糖尿病、当前吸烟、收缩压、总胆固醇和高密度脂蛋白胆固醇计算的。认知表现通过基线和随访时的认知测试来测量。计算10项认知测试的z分数;测试分为五个认知领域,平均得出一个领域得分。最后,对各领域得分进行平均,得出一个全局认知得分。进行了线性混合效应分析,其中按受试者拦截(随机效应)和固定效应(SCORE2-OP,瑞典语为第一语言,中学后教育和时间点)评估其影响认知水平和变化的能力。在一个单独的模型中测试了时间和SCORE2-OP之间的相互作用项,以研究SCORE2-OP与认知变化之间的关系。在排除心血管疾病、痴呆或缺少随访数据的个体后进行敏感性分析。结果SCORE2-OP与整体认知水平降低相关(β=-0.016, p≤0.001),见图1,但与认知能力下降无关(交互作用期时间*SCORE2-OP p =.163)。排除患有心血管疾病、痴呆和没有随访的个体并没有改变结果。结论:这些发现表明,用SCORE2-OP测量的心血管风险升高与整体认知水平降低之间存在关联,而不是下降。为了进一步评估SCORE2-OP与认知能力下降之间的关系,需要在更多的时间点和更长时间的随访中评估认知表现。未来的研究应该调查认知领域之间的关联是否不同,并评估心血管风险和神经退行性疾病之间的潜在相互作用。总之,研究结果表明,心血管健康和认知是相关的,治疗心血管危险因素可能有助于认知健康。
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引用次数: 0
Characterization of brain barrier fluorescent reporter mouse models of cerebral amyloid angiopathy 脑屏障荧光报告小鼠脑淀粉样血管病模型的表征
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100491
Urban Deutsch, Britta Engelhardt, Steven T. Proulx, Linh Tran

Introduction

There is renewed interest in how central nervous system (CNS) fluids and barriers contribute to neurological disorders, including cerebral amyloid angiopathy (CAA). Evidence suggests that impaired clearance of amyloid-β (Aβ) plays a role in CAA formation, highlighting the need to better understand brain fluid clearance mechanisms. Nonetheless, the mechanisms for fluid circulation and solute exchange in the brain remain debated, and many studies overlook the brain’s compartmentalizing barriers. To address this gap, we developed new transgenic mouse models to visualize key CNS barriers.

Methods

We have developed two dual-reporter mouse strains: a Vascular reporter (Claudin5-GFP for cerebral vessels, Prox1-tdTom for lymphatics) and a Border reporter (Aqp4-mRuby3 for astrocytic glia limitans, VE-cadherin-GFP for leptomeninges and blood vessels). These two strains were crossed with the ArcAβ transgenic line, yielding two triple- transgenic models of cerebral amyloidosis. We analyzed Aβ deposition at different disease stages and examined solute distribution after parenchymal tracer infusion using ex vivo imaging of decalcified skulls and fixed brains.

Results

Aβ deposition patterns and tracer studies revealed multiple drainage pathways that are dependent on the region of the brain and the size of the solute. These include transport along white matter tracts and across the glia limitans—findings that diverge from the popular “glymphatic” model of perivascular bulk flow. Aβ was found to accumulate at the leptomeninges in a pattern that was not always associated with pial blood vessels. The potential links between Aβ accumulation and changes in barrier integrity are under further investigation.

Conclusions

Our novel reporter models provide powerful tools to study CNS barriers and solute clearance in CAA. These findings offer new insights into alternative drainage mechanisms besides glymphatic flow. The involvement of each pathway upon the onset of Aβ deposition remains to be elucidated and we speculate that certain types of deposition result from the rerouting of clearance due to the failure of other pathways. Future validation with in vivo imaging techniques, such as two-photon microscopy and synchrotron X-ray imaging, will further elucidate the spatial and functional dynamics of fluid movement in the diseased brain.
关于中枢神经系统(CNS)液体和屏障如何导致包括脑淀粉样血管病(CAA)在内的神经系统疾病,人们重新产生了兴趣。有证据表明,淀粉样蛋白-β (a β)的清除受损在CAA形成中起作用,这突出了更好地了解脑液清除机制的必要性。尽管如此,大脑中液体循环和溶质交换的机制仍然存在争议,许多研究忽略了大脑的区隔障碍。为了解决这一差距,我们开发了新的转基因小鼠模型来可视化关键的中枢神经系统屏障。方法建立了两种双报告小鼠品系:血管报告品系(脑血管报告品系claud5 - gfp,淋巴管报告品系Prox1-tdTom)和边界报告品系(星形胶质细胞局限性报告品系Aqp4-mRuby3,轻脑膜和血管报告品系VE-cadherin-GFP)。将这两株菌株与ArcAβ转基因系杂交,得到两种三重转基因脑淀粉样变性模型。我们利用脱钙颅骨和固定脑的离体成像分析了Aβ在不同疾病阶段的沉积,并检测了脑实质示踪剂输注后的溶质分布。结果sa β沉积模式和示踪剂研究揭示了多种依赖于脑区域和溶质大小的排水途径。这些包括沿白质束和跨越胶质细胞界限的运输——这些发现与流行的“类淋巴”血管周围大流量模型不同。发现a β以一种并不总是与头枕血管相关的模式积聚在轻脑膜。Aβ积累与屏障完整性改变之间的潜在联系正在进一步研究中。结论新的报告因子模型为研究CAA中中枢神经系统屏障和溶质清除提供了有力的工具。这些发现提供了新的见解,以替代排水机制除了淋巴流动。每个途径在Aβ沉积开始时的参与仍有待阐明,我们推测某些类型的沉积是由于其他途径的失败而导致清除的改变。未来体内成像技术的验证,如双光子显微镜和同步加速器x射线成像,将进一步阐明病变大脑中流体运动的空间和功能动力学。
{"title":"Characterization of brain barrier fluorescent reporter mouse models of cerebral amyloid angiopathy","authors":"Urban Deutsch,&nbsp;Britta Engelhardt,&nbsp;Steven T. Proulx,&nbsp;Linh Tran","doi":"10.1016/j.cccb.2025.100491","DOIUrl":"10.1016/j.cccb.2025.100491","url":null,"abstract":"<div><h3>Introduction</h3><div>There is renewed interest in how central nervous system (CNS) fluids and barriers contribute to neurological disorders, including cerebral amyloid angiopathy (CAA). Evidence suggests that impaired clearance of amyloid-β (Aβ) plays a role in CAA formation, highlighting the need to better understand brain fluid clearance mechanisms. Nonetheless, the mechanisms for fluid circulation and solute exchange in the brain remain debated, and many studies overlook the brain’s compartmentalizing barriers. To address this gap, we developed new transgenic mouse models to visualize key CNS barriers.</div></div><div><h3>Methods</h3><div>We have developed two dual-reporter mouse strains: a Vascular reporter (Claudin5-GFP for cerebral vessels, Prox1-tdTom for lymphatics) and a Border reporter (Aqp4-mRuby3 for astrocytic glia limitans, VE-cadherin-GFP for leptomeninges and blood vessels). These two strains were crossed with the ArcAβ transgenic line, yielding two triple- transgenic models of cerebral amyloidosis. We analyzed Aβ deposition at different disease stages and examined solute distribution after parenchymal tracer infusion using ex vivo imaging of decalcified skulls and fixed brains.</div></div><div><h3>Results</h3><div>Aβ deposition patterns and tracer studies revealed multiple drainage pathways that are dependent on the region of the brain and the size of the solute. These include transport along white matter tracts and across the glia limitans—findings that diverge from the popular “glymphatic” model of perivascular bulk flow. Aβ was found to accumulate at the leptomeninges in a pattern that was not always associated with pial blood vessels. The potential links between Aβ accumulation and changes in barrier integrity are under further investigation.</div></div><div><h3>Conclusions</h3><div>Our novel reporter models provide powerful tools to study CNS barriers and solute clearance in CAA. These findings offer new insights into alternative drainage mechanisms besides glymphatic flow. The involvement of each pathway upon the onset of Aβ deposition remains to be elucidated and we speculate that certain types of deposition result from the rerouting of clearance due to the failure of other pathways. Future validation with in vivo imaging techniques, such as two-photon microscopy and synchrotron X-ray imaging, will further elucidate the spatial and functional dynamics of fluid movement in the diseased brain.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"9 ","pages":"Article 100491"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145796797","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
A novel amyloid-to-integrin interaction underlies the reduction in brain blood flow in early Alzheimer's disease 一种新的淀粉样蛋白-整合素相互作用是早期阿尔茨海默病脑血流量减少的基础
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100486
Ella M Hastings , Katy R Walsh , Junzhe Zha , Lowri E Evans , Thea G E Danby , Harry A T Pritchard , Martin J Humphries , Ingo Schiessl , Mark T Nelson , Adam S Greenstein

Introduction

The reduction in brain blood flow seen in patients with early Alzheimer's disease is a therapeutic target to slow progression. We recently identified Amyloid-β(1-40) (Aβ1-40) as the molecular culprit responsible for this reduction in flow, due to induction of pro-contractile Ca2+ waves within vascular smooth muscle cells (VSMC) of pial arteries, mimicking the phenotype of 18-month old APP23 mice. Here, we present the molecular mechanism by which Aβ1-40 induces this vascular pathology, inviting imminent drug development.

Methods

9 month APP23 and WT mice were studied using Laser Speckle Contrast imaging to quantify cerebral blood flow and behaviourally, the Y-maze. Pial arteries from these and 12 week C57Bl6/J mice were studied using pressure myography and high-speed spinning disc confocal microscopy to image VSMC Ca2+ events. Biacore Surface Plasmon Resonance (SPR) and Electron Microscopy quantified Aβ1-40 binding to VSMC integrins.

Results

At 9 months of age, APP23 mice showed reduced cerebral blood flow compared with WT mice, although behaviour was equivalent. There was an excess of pathological Ca2+ waves in APP23 mice (APP23: 0.07±0.01 vs WT: 0.026±0.05, p<0.001: waves/cell/s), indicating an Aβ1-40-induced intermediate ‘vascular phenotype’. Aβ1-40 very strongly bound integrins of pial artery VSMC (KD: 2.8E-10M to αVβ5 integrin). A single amino acid substitution within a previously undetected RGD-like domain within Aβ1-40: Aspartate 7 to Alanine 7 (henceforth: Ala-7) prevented binding to αVβ5 integrin (KD: undetectable), although fibril formation remained normal. Similarly, Ala-7, did not induce pathological Ca2+ waves (10nM Aβ1-40: 0.2±0.03 vs 10nM Ala-7: 0.01±0.006, p<0.001: waves/cell/s). Further single point substitutions within Aβ1-40 indicated both intact fibril and preservation of the RGD-like domain were needed for integrin binding and Ca2+ wave initiation.
Similarly, 10nM Aβ1-40 constricted pial arteries with stable myogenic tone by 10.9±2.07%, significantly greater than Ala7 (2.2±0.95%, p=0.005,) or a scrambled Aβ1-40 peptide (2.2±1.96%, p=0.007). Pre-incubation with Cilengitide, a specific integrin antagonist, prevented both Aβ1-40-induced Ca2+ waves and constriction of the arteries.

Conclusions

An RGD-like domain within Aβ1-40 binds VSMC integrins to initiate pro- contractile Ca2+ waves, accounting for reduction in cerebral blood flow. This intermediate phenotype, preceding cognitive dysfunction, is a novel druggable target.
早期阿尔茨海默病患者的脑血流量减少是减缓病情进展的治疗靶点。我们最近发现淀粉样蛋白-β(1-40) (Aβ1-40)是导致这种血流减少的分子罪魁祸首,这是由于在头动脉血管平滑肌细胞(VSMC)内诱导促收缩Ca2+波,模仿18个月大的APP23小鼠的表型。在这里,我们提出了Aβ1-40诱导这种血管病理的分子机制,并提出了迫在眉睫的药物开发。方法采用激光散斑对比成像技术对9月龄大鼠APP23和WT进行脑血流定量和y型迷宫行为学研究。使用压力肌图和高速旋转盘共聚焦显微镜对这些小鼠和12周C57Bl6/J小鼠的脑脊膜动脉进行研究,以成像VSMC Ca2+事件。Biacore表面等离子体共振(SPR)和电子显微镜定量了Aβ1-40与VSMC整合素的结合。结果在9个月大时,APP23小鼠与WT小鼠相比,脑血流量减少,尽管行为相同。APP23小鼠的病理Ca2+波过量(APP23: 0.07±0.01 vs WT: 0.026±0.05,p<;0.001:波/细胞/秒),表明a β1-40诱导的中间“血管表型”。α - β1-40与α - v - β5整合素结合非常强(KD: 2.8E-10M)。在Aβ1-40中先前未检测到的rgd样结构域内的单个氨基酸替换:天冬氨酸7到丙氨酸7(以下称为Ala-7)阻止了与αVβ5整合素的结合(KD:未检测到),尽管纤维形成保持正常。同样,Ala-7也不会诱导病理Ca2+波(10nM a- β1-40: 0.2±0.03 vs 10nM Ala-7: 0.01±0.006,p<;0.001:波/细胞/秒)。进一步在Aβ1-40内进行单点替换表明,整合素结合和Ca2+波起始需要完整的原纤维和rgd样结构域的保存。同样,10nM a - β1-40缩窄心动脉,肌张力稳定,收缩率为10.9±2.07%,显著高于Ala7(2.2±0.95%,p=0.005,)或a - β1-40缩窄肽(2.2±1.96%,p=0.007)。用特异性整合素拮抗剂西伦吉肽(Cilengitide)预先孵育,可以阻止a β1-40诱导的Ca2+波和动脉收缩。结论Aβ1-40中的rgd样结构域与VSMC整合素结合,引发促收缩Ca2+波,导致脑血流量减少。这种中间表型,先于认知功能障碍,是一种新的药物靶点。
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引用次数: 0
Neurofilament Light and GFAP as prognostic biomarkers of cognitive outcomes after stroke: a 5-year prospective multi-centre cohort study 神经丝光和GFAP作为脑卒中后认知结果的预后生物标志物:一项5年前瞻性多中心队列研究
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100412
Jule Filler , Marco Duering , Michael Goertler , Silke Wunderlich , Inga Zerr , Matthias Endres , Gabor Petzold , Martin Dichgans , Steffen Tiedt

Introduction

Cognitive impairment is a common consequence of stroke, yet early identification of patients at risk remains challenging. Blood-based biomarkers of neuroaxonal and astroglial injury, such as neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP), may improve risk stratification, but evidence on their prognostic value for long-term cognitive outcomes is limited.

Methods

We conducted a prospective cohort study of dementia-free patients with ischaemic or haemorrhagic stroke admitted to six German tertiary stroke centres between May 2011 and January 2019 (DEMDAS; NCT01334749). Baseline blood samples were collected at a median of 3 days (IQR 2–5) post-stroke, and plasma NfL and GFAP were measured using the Simoa platform. Neuropsychological assessments were performed at 6, 12, 36, and 60 months. The primary outcome was post-stroke cognitive impairment (PSCI), defined as ≥1 domain <-1.5 SD. Secondary outcomes included global cognitive performance and domain-specific impairments. Associations of baseline biomarkers with outcomes over 5 years were estimated using generalized estimating equations, adjusted for demographics, stroke severity, acute-phase cognition, vascular risk factors, imaging parameters, and time to sampling. We also assessed model improvement and subgroup effects.

Results

Among 558 patients with baseline biomarker data, higher NfL was significantly associated with PSCI (OR=1.57, 95% CI 1.28–1.91, p<0.0001), while GFAP was not. NfL also predicted worse global cognitive performance (β=–0.11, 95% CI –0.20 to –0.03, p=0.007) and impairments in the attention (OR=1.90, 1.38–2.60) and executive (OR=1.30, 1.04–1.62) domains. NfL improved model fit for PSCI and cognitive performance beyond clinical predictors, although gains in explained variance and discrimination were modest.
The prognostic value of NfL was particularly pronounced in patients with poorer performance on acute-phase Montreal Cognitive Assessment (MoCA).

Conclusions

Baseline plasma NfL was independently associated with cognitive outcomes over five years after stroke, especially in domains that are commonly affected by vascular pathology. Future studies should explore the benefits of longitudinal NfL monitoring for timely risk stratification and its potential to guide patient selection for clinical trials targeting post-stroke cognitive impairment.
认知障碍是中风的常见后果,但早期识别患者的风险仍然具有挑战性。神经轴突和星形胶质损伤的血液生物标志物,如神经丝轻链(NfL)和胶质纤维酸性蛋白(GFAP),可能改善风险分层,但其对长期认知结果的预后价值的证据有限。方法:我们对2011年5月至2019年1月期间在6个德国三级卒中中心(DEMDAS; NCT01334749)住院的无痴呆缺血性或出血性卒中患者进行了一项前瞻性队列研究。在中风后中位数3天(IQR 2-5)采集基线血液样本,并使用Simoa平台测量血浆NfL和GFAP。分别在6、12、36和60个月进行神经心理评估。主要终点为脑卒中后认知障碍(PSCI),定义为≥1域-1.5 SD。次要结果包括整体认知表现和领域特异性损伤。基线生物标志物与5年预后的相关性使用广义估计方程进行估计,并根据人口统计学、卒中严重程度、急性期认知、血管危险因素、成像参数和采样时间进行调整。我们还评估了模型改进和亚组效应。结果在558例具有基线生物标志物数据的患者中,较高的NfL与PSCI显著相关(OR=1.57, 95% CI 1.28-1.91, p<0.0001),而GFAP则无关。NfL还预测更差的整体认知表现(β= -0.11, 95% CI -0.20至-0.03,p=0.007)和注意力(OR=1.90, 1.38-2.60)和执行(OR=1.30, 1.04-1.62)领域的损伤。NfL改进的模型适合PSCI和超越临床预测的认知表现,尽管在解释方差和歧视方面的收益不大。对于急性期蒙特利尔认知评估(MoCA)表现较差的患者,NfL的预后价值尤为显著。结论:基线血浆NfL与脑卒中后5年内的认知结果独立相关,特别是在通常受血管病理影响的脑区。未来的研究应探索纵向NfL监测对及时进行风险分层的益处,以及其指导患者选择针对脑卒中后认知障碍的临床试验的潜力。
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引用次数: 0
Multi-trait Genome-wide analysis of Vascular Dementia and Related Endophenotypes Reveals Shared Etiology and Novel Genetic Loci 血管性痴呆及其相关内表型的多性状全基因组分析揭示了共同的病因和新的遗传位点
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100451
Jingxian Huang , Fotios Koskeridis , Devendra Meena , Abbas Dehghan , Ioanna Tzoulaki

Introduction

Vascular dementia (VaD), the second most common form of dementia after Alzheimer's disease, arises from a complex interplay between genetic predisposition and vascular risk factors. Genome-wide association studies (GWAS) have so far identified only a small number of genetic variants linked to VaD, mainly due to insufficient power and the heterogeneity in disease pathology which cannot be fully captured by single-trait GWAS.

Methods

We applied LD Score regression and multi-trait analyses of GWAS (MTAG) to map shared genetic architecture and pleiotropic loci between VaD and related endophenotypes (small-vessel stroke, cerebral infarction and microbleeds, MRI markers of white matter hyperintensities, and extensive perivascular space (PVS) burden). We further performed genetic colocalization and fine mapping to pinpoint potential genetic risk factors with pleiotropic effects shared across VaD, different vascular pathologies of VaD, tissue- specific gene expression, and circulating levels of plasm proteome, in the corresponding risk loci identified through the MTAG.

Results

We found that VaD demonstrated moderate genetic correlations with small-vessel stroke (rg = 0.50), mean diffusivity (rg = 0.43), and extensive PVS burden at basal ganglia (PVS-BG; rg = 0.49). Across the pairwise bivariate MTAG, we identified three distinct genetic loci associated with VaD at genome-wide significance level (PMTAG < 5 × 10-8), representing 42 unique signals. Of these, PRDM16 (rs2455132) was a novel locus for VaD. In addition, we identified 33 distinct loci associated with different VaD endophenotypes, and CENPA (rs714447) was identified as a novel locus for PVS-BG (PMTAG = 9.79 × 10-9).
Genetic colocalization prioritized 15 regions where ≥ 2 phenotypes show evidence of colocalization (posterior probability > 0.5). In 5 of the regions (PRDM16, CENPA, AL662890.1, TCF25, and APOC1-APOE-PVRL2), we found that VaD colocalized with at least one endophenotypes and further with gene expression level. In the novel VaD locus (PRDM16), VaD colocalized with small-vessel stroke and PRDM16-DT expression in tibial artery.

Conclusions

Our findings provide novel insights into the understanding of genetic pleiotropy and potential shared mechanisms between VaD and different vascular pathologies captured by endophenotypes, with implications for future prevention and therapeutic strategies.
血管性痴呆(VaD)是仅次于阿尔茨海默病的第二种最常见的痴呆形式,是由遗传易感性和血管危险因素之间复杂的相互作用引起的。迄今为止,全基因组关联研究(GWAS)仅发现了少量与VaD相关的遗传变异,这主要是由于能力不足和疾病病理的异质性,单性状GWAS无法完全捕获。方法应用LD评分回归和GWAS (MTAG)多性状分析,绘制VaD与相关内表型(小血管卒中、脑梗死和微出血、白质高信号的MRI标记物和广泛血管周围空间(PVS)负担)之间的共同遗传结构和多效位点。我们进一步进行了遗传共定位和精细定位,以确定在通过MTAG识别的相应风险位点中,VaD、VaD的不同血管病理、组织特异性基因表达和血浆蛋白质组循环水平中具有多效性的潜在遗传风险因素。结果我们发现VaD与小血管卒中(rg = 0.50)、平均扩散率(rg = 0.43)和基底节区广泛的PVS负担(PVS- bg; rg = 0.49)具有中度遗传相关性。在双变量MTAG中,我们在全基因组显著性水平上发现了三个与VaD相关的不同遗传位点(PMTAG < 5 × 10-8),代表了42个独特的信号。其中,PRDM16 (rs2455132)是VaD的新位点。此外,我们鉴定了33个与不同VaD内表型相关的不同位点,并鉴定出CENPA (rs714447)是PVS-BG的新位点(PMTAG = 9.79 × 10-9)。遗传共定位优先考虑15个区域,其中≥2种表型显示共定位的证据(后验概率>; 0.5)。在其中的5个区域(PRDM16、CENPA、AL662890.1、TCF25和APOC1-APOE-PVRL2)中,我们发现VaD至少与一种内表型共定位,并进一步与基因表达水平共定位。在新的VaD位点(PRDM16)中,VaD与小血管卒中和PRDM16- dt在胫骨动脉中的表达共定位。结论我们的研究结果为了解VaD与不同血管病理之间的遗传多效性和潜在的共享机制提供了新的见解,对未来的预防和治疗策略具有重要意义。
{"title":"Multi-trait Genome-wide analysis of Vascular Dementia and Related Endophenotypes Reveals Shared Etiology and Novel Genetic Loci","authors":"Jingxian Huang ,&nbsp;Fotios Koskeridis ,&nbsp;Devendra Meena ,&nbsp;Abbas Dehghan ,&nbsp;Ioanna Tzoulaki","doi":"10.1016/j.cccb.2025.100451","DOIUrl":"10.1016/j.cccb.2025.100451","url":null,"abstract":"<div><h3>Introduction</h3><div>Vascular dementia (VaD), the second most common form of dementia after Alzheimer's disease, arises from a complex interplay between genetic predisposition and vascular risk factors. Genome-wide association studies (GWAS) have so far identified only a small number of genetic variants linked to VaD, mainly due to insufficient power and the heterogeneity in disease pathology which cannot be fully captured by single-trait GWAS.</div></div><div><h3>Methods</h3><div>We applied LD Score regression and multi-trait analyses of GWAS (MTAG) to map shared genetic architecture and pleiotropic loci between VaD and related endophenotypes (small-vessel stroke, cerebral infarction and microbleeds, MRI markers of white matter hyperintensities, and extensive perivascular space (PVS) burden). We further performed genetic colocalization and fine mapping to pinpoint potential genetic risk factors with pleiotropic effects shared across VaD, different vascular pathologies of VaD, tissue- specific gene expression, and circulating levels of plasm proteome, in the corresponding risk loci identified through the MTAG.</div></div><div><h3>Results</h3><div>We found that VaD demonstrated moderate genetic correlations with small-vessel stroke (rg = 0.50), mean diffusivity (rg = 0.43), and extensive PVS burden at basal ganglia (PVS-BG; rg = 0.49). Across the pairwise bivariate MTAG, we identified three distinct genetic loci associated with VaD at genome-wide significance level (PMTAG &lt; 5 × 10-8), representing 42 unique signals. Of these, PRDM16 (rs2455132) was a novel locus for VaD. In addition, we identified 33 distinct loci associated with different VaD endophenotypes, and CENPA (rs714447) was identified as a novel locus for PVS-BG (PMTAG = 9.79 × 10-9).</div><div>Genetic colocalization prioritized 15 regions where ≥ 2 phenotypes show evidence of colocalization (posterior probability &gt; 0.5). In 5 of the regions (PRDM16, CENPA, AL662890.1, TCF25, and APOC1-APOE-PVRL2), we found that VaD colocalized with at least one endophenotypes and further with gene expression level. In the novel VaD locus (PRDM16), VaD colocalized with small-vessel stroke and PRDM16-DT expression in tibial artery.</div></div><div><h3>Conclusions</h3><div>Our findings provide novel insights into the understanding of genetic pleiotropy and potential shared mechanisms between VaD and different vascular pathologies captured by endophenotypes, with implications for future prevention and therapeutic strategies.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"9 ","pages":"Article 100451"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797092","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
The role of race or residence on the burden and risk factors for cerebral small vessel disease in individuals with incident stroke or transient ischemic attack 种族或居住地对偶发性脑卒中或短暂性脑缺血发作个体的脑血管疾病负担和危险因素的影响
IF 2.8 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100441
Oluchi Ekenze , Russell P. Sawyer , Liang Niu , Hugo J. Aparicio , Sudha Seshadri , Virginia J. Howard , George Howard , Jose R. Romero , Hyacinth I. Hyacinth

Introduction

Cerebral small vessel disease (CSVD) is associated with a higher risk of stroke, cognitive impairment, and dementia. We examined the association of race (Black vs. White) and/or residence (stroke belt vs non-stroke belt), with the total or regional brain burden of CSVD markers including cerebral microbleeds, (CMB), enlarged perivascular spaces (ePVS), and white matter hyperintensity volume (WMHV), among participants in the REason for Geographic And Racial Differences in Stroke study.

Methods

CMB and ePVS were visually rated using the STRIVE criteria and WMHV was estimated using the unidentified bright object detector software pipeline. Presence or absence of CMB was classified whole brain (any CMB), non-lobar only, lobar only, mixed CMB (non-lobar and lobar) and we recorded total CMB count. ePVS was rated in the basal ganglia (BG) and centrum semiovale (CSO) and classified as high (grade ≥2 in the BG or ≥3 in CSO) or low (grade <2) burden. Exposures were race or residence. Our data analysis used multivariable logistic (for CMB presence/location and ePVS burden), negative binomial (for CMB count), and linear (for WMHV) regression. Models were adjusted for relevant demographic and vascular risk factors, socioeconomic status and APOE (for WMHV analysis) genotype.

Results

Our sample sizes are 808 for CMB, 1108 for ePVS, and 1094 for WMHV. Prevalence of CMBs and high ePVS burden in the BG and CSO were 26% and 82 and 67% respectively. Stroke belt residents with CMB and/or high ePVS burden in the BG or CSO were younger compared to non-stroke belt residents. Black participants with CMBs and/or high ePVS burden in the BG or CSO ePVS were also younger compared to White participants irrespective of residence. Overall, Black participants had higher risk of any CMB (1.72, 1.22–2.43), larger WMHV in the whole brain (β=0.36, p<0.001), periventricular (β=0.35, p<0.001) and deep (β=0.42, p<0.001) regions. Irrespective of race, stroke-belt residency was associated with a lower risk of CMB burden and counts. No significant interaction effect was observed.

Conclusions

The relationship between race or stroke belt residence and CSVD burden was marker related. Future studies using the overall CSVD burden are ongoing in this population.
脑血管病(CSVD)与卒中、认知障碍和痴呆的高风险相关。我们研究了种族(黑人与白人)和/或居住地(卒中带与非卒中带)与CSVD标志物(包括脑微出血(CMB)、血管周围空间扩大(ePVS)和白质高强度体积(WMHV))的总或区域脑负担的关系,这些标志物包括卒中研究中地理和种族差异的原因。方法采用STRIVE标准对scmb和ePVS进行目测评定,使用未识别亮物检测器软件pipeline对WMHV进行估计。存在或不存在CMB分为全脑(任何CMB)、非脑叶性、仅脑叶性、混合性CMB(非脑叶性和脑叶性),并记录CMB总数。ePVS在基底节区(BG)和半瓣膜区(CSO)进行评分,分为高负荷(BG≥2级或CSO≥3级)和低负荷(<;2级)。暴露是种族或居住地。我们的数据分析使用了多变量逻辑(CMB存在/位置和ePVS负担)、负二项(CMB计数)和线性(WMHV)回归。根据相关的人口统计学和血管危险因素、社会经济状况和APOE(用于WMHV分析)基因型对模型进行调整。结果CMB样本容量为808个,ePVS为1108个,WMHV为1094个。BG和CSO中CMBs和高ePVS负担的患病率分别为26%、82%和67%。与非卒中带居民相比,卒中带居民在BG或CSO中具有CMB和/或高ePVS负担。在BG或CSO ePVS中患有CMBs和/或高ePVS负担的黑人参与者与白人参与者相比也更年轻,无论居住地如何。总体而言,黑人受试者有较高的CMB(1.72, 1.22-2.43)、全脑WMHV (β=0.36, p<0.001)、脑室周围(β=0.35, p<0.001)和深部(β=0.42, p<0.001)的风险。不论种族,卒中带居住与CMB负担和计数的风险较低相关。未观察到显著的相互作用效应。结论种族或脑卒中带居住与心血管疾病负担存在显著相关。在这一人群中使用总体心血管疾病负担的未来研究正在进行中。
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引用次数: 0
Mid-life association between cardiovascular risk factors and cerebral blood flow in a multi-ethnic population 多民族人群中年心血管危险因素与脑血流量的关系
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100384
Esther M.C. Vriend , Mathijs B.J. Dijsselhof , Thomas A. Bouwmeester , Oscar H. Franco , Henrike Galenkamp , Didier Collard , Aart J. Nederveen , Bert-Jan H. van den Born , Henk J.M.M. Mutsaerts

Background

Cardiovascular (CV) risk factors are associated with cerebrovascular damage and cognitive decline in late-life. However, it is unknown how different ethnic CV risk profiles relate to cerebral haemodynamics in mid-life. We aimed to investigate associations of CV risk factors with cerebral haemodynamics at two timepoints and examine the impact of ethnicity on these measures.

Methods

From the HELIUS study (53.0 years, 44.8 % female), participants of Dutch (n = 236), Moroccan (n = 122), or South-Asian Surinamese (n = 173) descent were included. Cerebral blood flow (CBF) and its spatial coefficient of variation (sCoV, an ASL-label arrival measure of macrovascular efficiency) were obtained in grey (GM) and white matter (WM). CV risk factors were assessed 8.4 years [7.4–9.5] (first visit) and 2.2 years [1.8–2.6] (second visit) prior to MRI. Associations of CV risk factors, WM hyperintensities (WMH), and carotid plaques with cerebral haemodynamics were investigated using linear regressions.

Results

CBF and sCoV differed per ethnicity. Only at the second visit associations were found, without an interaction with ethnicity; history of CV disease with lower GM CBF and higher WM sCoV, higher total cholesterol and lower WMH volume with lower WM CBF, smoking with higher WM sCoV, and higher SBP with lower GM sCoV.

Conclusions

These findings suggest that cerebral haemodynamics differ between ethnic groups in midlife. Although no interaction with ethnicity was found in the associations of CV risk factors, the observed differences in CBF and sCoV highlight the need to further explore how ethnic-specific risk profiles may contribute to cerebrovascular pathology over time.
背景:心血管(CV)危险因素与晚年脑血管损伤和认知能力下降有关。然而,目前尚不清楚不同种族的心血管风险特征与中年脑血流动力学的关系。我们的目的是在两个时间点调查CV危险因素与脑血流动力学的关系,并检查种族对这些措施的影响。方法从HELIUS研究(53.0岁,44.8%女性)中,纳入荷兰(n = 236)、摩洛哥(n = 122)或南亚苏里南(n = 173)血统的参与者。测定脑灰质(GM)和白质(WM)脑血流量(CBF)及其空间变异系数(sCoV, asl标记的大血管效率到达指标)。在MRI前8.4年[7.4-9.5](第一次就诊)和2.2年[1.8-2.6](第二次就诊)评估CV危险因素。使用线性回归研究了心血管危险因素、颈动脉高强度(WMH)和颈动脉斑块与脑血流动力学的关系。结果不同种族的scbf和sCoV存在差异。只有在第二次访问时才发现了与种族无关的关联;有心血管疾病史,GM CBF较低,WM sCoV较高,总胆固醇较高,WMH体积较小,WM CBF较低,吸烟,WM sCoV较高,SBP较高,GM sCoV较低。结论不同种族的中年人脑血流动力学存在差异。虽然没有发现心血管危险因素与种族的相互作用,但观察到的CBF和sCoV的差异突出了进一步探索种族特异性风险特征如何随着时间的推移导致脑血管病理的必要性。
{"title":"Mid-life association between cardiovascular risk factors and cerebral blood flow in a multi-ethnic population","authors":"Esther M.C. Vriend ,&nbsp;Mathijs B.J. Dijsselhof ,&nbsp;Thomas A. Bouwmeester ,&nbsp;Oscar H. Franco ,&nbsp;Henrike Galenkamp ,&nbsp;Didier Collard ,&nbsp;Aart J. Nederveen ,&nbsp;Bert-Jan H. van den Born ,&nbsp;Henk J.M.M. Mutsaerts","doi":"10.1016/j.cccb.2025.100384","DOIUrl":"10.1016/j.cccb.2025.100384","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular (CV) risk factors are associated with cerebrovascular damage and cognitive decline in late-life. However, it is unknown how different ethnic CV risk profiles relate to cerebral haemodynamics in mid-life. We aimed to investigate associations of CV risk factors with cerebral haemodynamics at two timepoints and examine the impact of ethnicity on these measures.</div></div><div><h3>Methods</h3><div>From the HELIUS study (53.0 years, 44.8 % female), participants of Dutch (<em>n</em> = 236), Moroccan (<em>n</em> = 122), or South-Asian Surinamese (<em>n</em> = 173) descent were included. Cerebral blood flow (CBF) and its spatial coefficient of variation (sCoV, an ASL-label arrival measure of macrovascular efficiency) were obtained in grey (GM) and white matter (WM). CV risk factors were assessed 8.4 years [7.4–9.5] (first visit) and 2.2 years [1.8–2.6] (second visit) prior to MRI. Associations of CV risk factors, WM hyperintensities (WMH), and carotid plaques with cerebral haemodynamics were investigated using linear regressions.</div></div><div><h3>Results</h3><div>CBF and sCoV differed per ethnicity. Only at the second visit associations were found, without an interaction with ethnicity; history of CV disease with lower GM CBF and higher WM sCoV, higher total cholesterol and lower WMH volume with lower WM CBF, smoking with higher WM sCoV, and higher SBP with lower GM sCoV.</div></div><div><h3>Conclusions</h3><div>These findings suggest that cerebral haemodynamics differ between ethnic groups in midlife. Although no interaction with ethnicity was found in the associations of CV risk factors, the observed differences in CBF and sCoV highlight the need to further explore how ethnic-specific risk profiles may contribute to cerebrovascular pathology over time.</div></div>","PeriodicalId":72549,"journal":{"name":"Cerebral circulation - cognition and behavior","volume":"8 ","pages":"Article 100384"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Permutations of cerebrovascular pathologies in older adults with and without diabetes 有和没有糖尿病的老年人脑血管病变的排列
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1016/j.cccb.2025.100381
Rupal I. Mehta, Ana W. Capuano, Roshni Biswas, David A. Bennett, Zoe Arvanitakis
Permutations of cerebrovascular pathologies (CVP) in persons with diabetes mellitus (DM) have not been comprehensively investigated. Here, we examine diverse postmortem CVP outcomes, including permutations of single or mixed CVP, in 2163 older adults with or without DM who were followed in longitudinal studies of aging. Annual clinical evaluations included data to classify DM status by medical history (DM diagnosis), direct medication inspection (anti-diabetic therapy), and hemoglobin A1C level (≥6.5 %). Upon death, neuropathological examinations were performed and included evaluation for CVP (considering vessel pathologies and brain infarcts) and Alzheimer's disease neuropathologic change (AD-NC). Among all participants [mean age, 89.49 ± 6.89 years (SD)], single CVP were more common than mixed CVP. Logistic regression was used to analyze the association of DM with CVP permutations, controlling for age at death, sex, education, and AD-NC, and revealed increased odds of microinfarcts alone (odds ratio, 1.56 [95 %CI, 1.03–2.35]) and mixed microinfarcts and macroinfarcts (odds ratio, 1.90 [95 %CI, 1.16–3.13]). These associations remained after adjusting for demographic factors and cohort or vascular comorbidities including stroke, heart disease, hypertension, claudication, smoking, and systolic blood pressure. Furthermore, after controlling for demographic factors as well as AD-NC and APOE type, mixed microinfarcts and macroinfarcts were associated with approximate threefold increased risk of dementia (odds ratio, 2.95 [95 %CI, 1.13–7.70]) in participants with DM. Evidence suggests that older adults living with DM have higher odds of microinfarcts and mixed microinfarcts and macroinfarcts in the absence of intracranial vessel pathologies that cannot be explained by vascular comorbidities, and in this population mixed microinfarcts and macroinfarcts are associated with higher odds of dementia.
糖尿病(DM)患者脑血管病变(CVP)的排列尚未得到全面的研究。在此,我们对2163名患有或不患有糖尿病的老年人进行了衰老纵向研究,研究了不同的死后CVP结果,包括单一或混合CVP的排列。年度临床评估包括根据病史(糖尿病诊断)、直接用药检查(抗糖尿病治疗)和血红蛋白A1C水平(≥6.5%)对糖尿病状态进行分类的数据。死亡后进行神经病理检查,包括CVP(考虑血管病理和脑梗死)和阿尔茨海默病神经病理改变(AD-NC)的评估。在所有参与者中[平均年龄89.49±6.89岁(SD)],单一CVP比混合CVP更常见。采用Logistic回归分析DM与CVP排列的相关性,控制死亡年龄、性别、教育程度和AD-NC,结果显示单独微梗死(优势比为1.56 [95% CI, 1.03-2.35])和混合微梗死和大梗死(优势比为1.90 [95% CI, 1.16-3.13])的几率增加。在调整了人口统计学因素和队列或血管合并症(包括中风、心脏病、高血压、跛行、吸烟和收缩压)后,这些相关性仍然存在。此外,在控制了人口统计学因素以及AD-NC和APOE类型后,糖尿病参与者的混合微梗死和大梗死与痴呆风险增加约三倍相关(优势比为2.95 [95% CI, 1.13-7.70])。证据表明,在没有血管合并症无法解释的颅内血管病变的情况下,患有糖尿病的老年人发生微梗死、混合微梗死和大梗死的几率更高。在这个人群中,混合的微梗死和大梗死与痴呆的高几率相关。
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Cerebral circulation - cognition and behavior
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