Figure 2 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Source publication
Background
Cardiovascular risk factors vary between ethnicities but little is known about their differential effects on white matter hyperintensities (WMH), an indicator of brain aging and burden of cerebrovascular disease.
Methods and Results
Brain magnetic resonance imaging scans from 213 people of South Asian and 256 of European ethnicity (tota...
Citations
... All subjects underwent MRI examination at University College Hospital using a 3T MRI system (Philips Achieva, Eindhoven, Netherlands) with an 8 channel phased array head coil, following a previously described protocol [31]. The imaging protocol included a sagittal T1-weighted 3D TFE sequence with specific parameters (TR/TE/TI 7/3.2/836 ms, flip-angle 18, voxel size 1mm 3 ). ...
... The imaging protocol included a sagittal T1-weighted 3D TFE sequence with specific parameters (TR/TE/TI 7/3.2/836 ms, flip-angle 18, voxel size 1mm 3 ). Cortical grey matter was automatically parcellated into lobes using Geodesic Information Flows (GIF), and these outputs were utilized in the BaMoS algorithm for automatic WMH segmentation [31]. The BaMoS algorithm employed unsupervised hierarchical model selection, enabling accurate identification and delineation of WMH. ...
Background
Cognitive function has an important role in determining the quality of life of older adults. Cardiovascular disease (CVD) is common in older people and may compromise cognitive performance; however, the extent to which this is related to carotid atherosclerosis is unclear.
Aim
We investigated associations between carotid atherosclerosis and cognitive function and neuroimaging markers of brain health in a UK multi-ethnic community-based sample including older people of European, South Asian, and African-Caribbean ethnicity.
Methods
Carotid plaques and intima-media thickness (cIMT) were assessed using ultrasound in 985 people (mean age 73.2y, 56 % male). Associations of carotid atherosclerosis with cognitive function (memory, executive function, language and CSI-D, a global measure of cognitive state) and neuroimaging measures (total brain volume, hippocampal volume, white matter (WM) lesion volume and coalescence score) were analysed using regression analyses, with and without adjustment for potential confounders using two models: 1) adjustment for age, sex, and ethnicity; 2) model 1 plus education, physical activity category, body mass index, hypertension, diabetes, total and high density lipoprotein cholesterol, atrial fibrillation, smoking, previous CVD, alcohol consumption, and presence of chronic kidney disease.
Results
People with carotid plaque or higher cIMT had lower CSI-D score, poorer memory poorer executive function and higher WM lesion volume and coalescence. Language was poorer in people with plaque but was not correlated with cIMT. Associations with plaque were preserved after full adjustment (model 2) but relationships for cIMT were attenuated. Associations with other plaque characteristics were generally unconvincing after adjustment.
Conclusions
This multi-ethnic cohort study provides evidence that presence of carotid plaque, is associated with poorer cognitive function and brain health.
... Regarding the association between brain imaging markers and glycemic control indices, a significant association between increased 2-hour blood glucose levels in the 75 g oral glucose tolerance test and gray matter atrophy in various brain regions has been reported. 13 While some studies found a significant association between high Hemoglobin A1c (HbA1c) levels and WMLs, 14 others found no significant association. 15 16 Although HbA1c is often used as a glycemic control indicator, it limitedly measures average blood glucose levels, and thus fails to adequately assess hypoglycemia or postprandial hyperglycemia. ...
Introduction
Although type 2 diabetes mellitus (T2DM) is associated with alterations in brain structure, the relationship between glycemic control indices and brain imaging markers remains unclear. This study aimed to investigate the association between continuous glucose monitoring (CGM)-derived glycemic control indices and brain imaging biomarkers assessed by MRI.
Research design and methods
This cross-sectional study included 150 patients with T2DM. The severity of cerebral white matter lesions (WMLs) was assessed using MRI for deep and subcortical white matter and periventricular hyperintensities. The degree of medial temporal lobe atrophy (MTA) was assessed using voxel-based morphometry. Each participant wore a retrospective CGM for 14 consecutive days, and glycemic control indices, such as time in range (TIR) and glycemia risk index (GRI), were calculated.
Results
The proportion of patients with severe WMLs showed a decreasing trend with increasing TIR ( P for trend=0.006). The proportion of patients with severe WMLs showed an increasing trend with worsening GRI ( P for trend=0.011). In contrast, no significant association was observed between the degree of MTA and CGM-derived glycemic control indices, including TIR ( P for trend=0.325) and GRI ( P for trend=0.447).
Conclusions
The findings of this study indicate that the severity of WMLs is associated with TIR and GRI, which are indices of the quality of glycemic control.
Trial registration number
UMIN000032143.
... Previous research has indicated larger WMH volumes in patients with diabetes, 30 though the effect's magnitude was reportedly limited, 31 and there are minimal reports on the specific topographic attributes of WMH in the context of diabetes. 32 As for hyperlipidemia, more severe periventricular WMH have been observed compared with those without this condition. 33 Furthermore, elevated low-density lipoprotein levels were associated with occipital periventricular WMH. ...
Background
This study explored the risk factors, neuroimaging features, and prognostic implications of nonhypertensive white matter hyperintensity (WMH) in patients with acute ischemic stroke and transient ischemic attack.
Methods and Results
We included 2283 patients with hypertension and 1003 without from a pool of 10 602. Associations of moderate‐to‐severe WMH with known risk factors, functional outcome, and a composite of recurrent stroke, myocardial infarction, and all‐cause mortality were evaluated. A subset of 351 patients without hypertension and age‐ and sex‐matched pairs with hypertension and moderate‐to‐severe WMH was created for a detailed topographic examination of WMH, lacunes, and microbleeds. Approximately 35% of patients without hypertension and 65% of patients with hypertensive stroke exhibited moderate‐to‐severe WMH. WMH was associated with age, female sex, and previous stroke, irrespective of hypertension. In patients without hypertension, WMH was associated with initial systolic blood pressure and was more common in the anterior temporal region. In patients with hypertension, WMH was associated with small vessel occlusion as a stroke mechanism and was more frequent in the periventricular region near the posterior horn of the lateral ventricle. The higher prevalence of occipital microbleeds in patients without hypertension and deep subcortical lacunes in patients with hypertension were also observed. Associations of moderate‐to‐severe WMH with 3‐month functional outcome and 1‐year cumulative incidence of the composite outcome were significant (both P <0.01), although the latter lost significance after adjustments. The associations between WMH and outcomes were consistent across hypertensive status.
Conclusions
One‐third of patients without hypertension with stroke have moderate‐to‐severe WMH. The pathogenesis of WMH may differ between patients without and with hypertension, but its impact on outcome appears similar.
... 2 Cardiovascular risk factors are shown to have a relationship with the cerebrovascular disease. Both macrovascular diseases such as hypertension and atherosclerosis, and microvascular diseases such as endothelial dysfunction have been associated with CSVD. 4 Age, hypertension (diastolic blood pressure), hyperlipidaemia, diabetes mellitus and smoking duration were strongly associated with WML in some studies 5,6 in a South Asian population, more so than in a European population. 6 There are few known multivariable risk scores used to project patients' risk of suffering from cardiovascular disease within 10 years after taking the test. ...
... Both macrovascular diseases such as hypertension and atherosclerosis, and microvascular diseases such as endothelial dysfunction have been associated with CSVD. 4 Age, hypertension (diastolic blood pressure), hyperlipidaemia, diabetes mellitus and smoking duration were strongly associated with WML in some studies 5,6 in a South Asian population, more so than in a European population. 6 There are few known multivariable risk scores used to project patients' risk of suffering from cardiovascular disease within 10 years after taking the test. The QRISK2 score used in this study is an improved version of the QRISK1 which include additional risk factors such as self-assigned ethnicity and conditions associated with cardiovascular risk. ...
... These findings are compatible with a recent study that showed that older age and higher cardiovascular risk factors are associated with an increasing WML burden in a South Asian population, as compared to a European one. 6 We also found that the RD insula cortex showed a significant negative association with the ARWMC score. Very little study on the DTI values of insula alone has been done previously. ...
Background & Objectives: The cerebral small vessel disease (CSVD) manifest as white matter lesion (WML) in magnetic resonance imaging (MRI). The diffusion tensor imaging (DTI) study shows a lower white matter integrity in white matter lesion (WML) and its penumbra region, suggesting cerebral white matter damage. The aim of this study is to establish correlation between the DTI values of white matter with the age related white matter changes (ARWMC) visual rating score and identify predictors of ARWMC score. Methods: 63 brain MRI images of subjects were selected. Relevant clinical information of the subjects which satisfied QRISK2 risk factors were retrieved from the patients’ folder. DTI parameters were obtained via postprocessing at OsiriX DTImap workstation. Results: FA frontal (r = -0.36; p = 0.003) and AD frontal (r = -0.26; p = 0.040) had a substantial and negative correlation with the ARWMC score. There was a significant positive correlation shown between the ARWMC score and RD frontal (r = 0.30; p = 0.018). There were positive significant association between the ARWMC score and age (b(95%CI): 0.106 (0.061, 0.151); p<0.001) and QRISK2 score (b(95%CI): 0.235 (0.036, 0.433)). Conclusion: DTI is a good method to study the cerebral white matter integrity. It was found that frontal lobe is the first region affected in relation to ageing, in particular the myelin integrity. Increasing age and higher QRISK2 cardiovascular risk factors were shown to increase the ARWMC score.
... In addition, the WMH age could be a good candidate marker for the risk of cognitive impairment in patients with other diseases that may increase the risk of WMH. (Sudre et al., 2018). ...
Introduction
Hypertension is associated with white matter hyperintensity (WMH) and cognitive impairment. Further, WMH is associated with cognitive impairment including executive, attention and visuospatial functions. The aim of this study was to investigate the effects of controlled hypertension (cHT) and previously developed concept, ‘WMH age’ on cognitive function and the mediating role of WMH in the effect of cHT on cognitive impairment.
Methods
We enrolled 855 Koreans without dementia aged 60 years or older, 326 of whom completed 2-year follow-up assessment. We measured their blood pressure thrice in a sitting position using an automated blood pressure monitoring device. We estimated ‘WMH age’ of every participant using previously developed WMH probability map of healthy older Koreans. We analyzed the mediating effect of WMH age in the association of cHT and cognitive function using the PROCESS Macro model.
Results
Old WMH age was associated with a faster decline in the Mini-Mental Status Examination (MMSE; p = .003), Consortium to Establish a Registry for Alzheimer’s Disease total score (CERAD-TS; p = .003), and Frontal Assessment Battery (FAB; p = .007). Old WMH age showed an approximately six times higher risk of incident mild cognitive impairment (OR = 6.47, 95% CI = 1.37 – 9.50, p = .024) compared to young or normal WMH age over the 2-year follow-up period in the cHT group. WMH age mediated the effects of cHT on the MMSE, CERAD-TS, and FAB scores at baseline and two-year follow-up period.
Conclusions
WMH mediates the adverse effect of hypertension on cognitive function. Elders with cHT who have older WMH age may be at a higher risk of cognitive decline.
... [28] and in the perivascular spaces (48%) [29]. Another study on different ethnic groups revealed that the prevalence of WMHs in Europeans was comparable to that of South Asians, however, older South Asian populations with known cardio-cerebrovascular risk factor/s may have a higher risk for WMHs burden [30]. In addition, data from several Asian countries, including Korea, Hong Kong, and Singapore showed a higher CSVD burden in Asian older adults, which is associated with cognitive deterioration [31]. ...
The nectar produced by bees in nature is known as honey and has been consumed for its nutritional and medicinal properties. There is growing evidence that honey and its compounds have anti-inflammatory, antioxidant and anti-microbial properties that are relevant to the maintenance of health and the prevention of illnesses, including cardiocerebrovascular disease. Cerebral small vessel disease (CSVD) is one of the major risk factors for diseases such as stroke, dementia, Alzheimer’s disease, and Parkinson’s disease. CSVD is prevalent with aging and the presence of vascular risk factors. Its most common deleterious effect on the brain parenchyma is a neurological problem, causing a spectrum of subtle clinical manifestations such as neurocognitive dysfunction, emotional or behavioral disturbances, and gait dysfunction. Moreover, the pathological mechanisms and preventive strategies for CSVD remain elusive, which is reflected in the continued lack of effective therapeutic and preventive therapies. Given the growing literature on honey and its compounds as a superfood-based preventive measure, this narrative review highlights the neuroprotective potentials of honey and its compounds in relation to the current understanding of CSVD pathomechanism.
... Due to the large number of analyses performed and sample size considerations, we limited the number of regions assessed to lobes and hemispheres. When sufficiently large sample sizes are available, breaking down the regions further based on distance from the ventricles as well as the basal ganglia such as the work by Sudre et al. 2018 might provide further information about the differences in WMH distribution patterns across different diagnostic groups . It also is worthwhile noting that the group definitions in the CCNA might differ from other studies in the literature. ...
Introduction
White matter hyperintensities (WMHs) are common magnetic resonance imaging (MRI) findings in the aging population in general, as well as in patients with neurodegenerative diseases. They are known to exacerbate the cognitive deficits and worsen the clinical outcomes in the patients. However, it is not well-understood whether there are disease-specific differences in prevalence and distribution of WMHs in different neurodegenerative disorders.
Methods
Data included 976 participants with cross-sectional T1-weighted and fluid attenuated inversion recovery (FLAIR) MRIs from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort of the Canadian Consortium on Neurodegeneration in Aging (CCNA) with eleven distinct diagnostic groups: cognitively intact elderly (CIE), subjective cognitive impairment (SCI), mild cognitive impairment (MCI), vascular MCI (V-MCI), Alzheimer’s dementia (AD), vascular AD (V-AD), frontotemporal dementia (FTD), Lewy body dementia (LBD), cognitively intact elderly with Parkinson’s disease (PD-CIE), cognitively impaired Parkinson’s disease (PD-CI), and mixed dementias. WMHs were segmented using a previously validated automated technique. WMH volumes in each lobe and hemisphere were compared against matched CIE individuals, as well as each other, and between men and women.
Results
All cognitively impaired diagnostic groups had significantly greater overall WMH volumes than the CIE group. Vascular groups (i.e. V-MCI, V-AD, and mixed dementia) had significantly greater WMH volumes than all other groups, except for FTD, which also had significantly greater WMH volumes than all non-vascular groups. Women tended to have lower WMH burden than men in most groups and regions, controlling for age. The left frontal lobe tended to have a lower WMH burden than the right in all groups. In contrast, the right occipital lobe tended to have greater WMH volumes than the left.
Conclusions
There were distinct differences in WMH prevalence and distribution across diagnostic groups, sexes, and in terms of asymmetry. WMH burden was significantly greater in all neurodegenerative dementia groups, likely encompassing areas exclusively impacted by neurodegeneration as well as areas related to cerebrovascular disease pathology.
... Frequency and progression patterns of sporadic cerebral small vessel disease (cSVD) have extensively been studied in White and Asian populations, and to a lesser degree in Blacks [1][2][3][4][5][6][7][8][9][10][11][12]. However, information from persons of Amerindian ancestry is lacking. ...
Background
Progression of cerebral small vessel disease (cSVD) markers has been studied in different races/ethnic groups. However, information from individuals of Amerindian ancestry is lacking. We sought to evaluate progression patterns of cSVD markers in community-dwelling older adults of Amerindian ancestry.Methods
Following a longitudinal prospective study design, participants of the Atahualpa Project Cohort aged ≥ 60 years received a baseline brain MRI and clinical interviews. Those who also received a brain MRI at the end of the study were included. Poisson regression models were fitted to assess cSVD markers progression according to their baseline load after a median follow-up of 6.5 ± 1.4 years. Logistic regression models were fitted to assess interrelations in the progression of the different cSVD markers at the end of the study.ResultsThe study included 263 individuals (mean age: 65.7 ± 6.2 years). Progression of white matter hyperintensities (WMH) was noticed in 103 (39%) subjects, cerebral microbleeds in 25 (12%), lacunes in 12 (5%), and enlarged basal ganglia-perivascular spaces (BG-PVS) in 56 (21%). Bivariate Poisson regression models showed significant associations between WMH severity at baseline and progression of WMH and enlarged BG-PVS. These associations became non-significant in multivariate models adjusted for clinical covariates. Logistic regression models showed interrelated progressions of WMH, cerebral microbleeds and enlarged BG-PVS. The progression of lacunes was independent.Conclusions
Patterns of cSVD marker progression in this population of Amerindians are different than those reported in other races/ethnic groups. The independent progression of lacunes suggests different pathogenic mechanisms with other cSVD markers.
... Taking these findings together, our work suggests that the basilar artery is particularly susceptible to the adverse effects of aging in South Asians, while there is evidence of a more marked association between age and length in African Caribbeans. These observations are consistent with the stronger associations between age and CSVD in South Asians and African Caribbeans, and their greater susceptibility to stroke (5) and, in the case of South Asians, white matter disease (26). Differences in remodeling patterns between South Asians and African Caribbeans might indicate that EVA is more severe in South Asians, since axial changes appear to be among the earlier manifestations of EVA (14). ...
Background and aims
Risk of stroke and dementia is markedly higher in people of South Asian and African Caribbean descent than white Europeans in the UK. This is unexplained by cardiovascular risk factors (CVRF). We hypothesized this might indicate accelerated early vascular aging (EVA) and that EVA might account for stronger associations between cerebral large artery characteristics and markers of small vessel disease.
Methods
360 participants in a tri-ethnic population-based study (120 per ethnic group) underwent cerebral and vertebral MRI. Length and median diameter of the basilar artery (BA) were derived from Time of Flight images, while white matter hyperintensities (WMH) volumes were obtained from T1 and FLAIR images. Associations between BA characteristics and CVRF were assessed using multivariable linear regression. Partial correlation coefficients between WMH load and BA characteristics were calculated after adjustment for CVRF and other potential confounders.
Results
BA diameter was strongly associated with age in South Asians (+11.3 μm/year 95% CI = [3.05; 19.62]; p = 0.008), with unconvincing relationships in African Caribbeans (3.4 μm/year [−5.26, 12.12]; p = 0.436) or Europeans (2.6 μm/year [−5.75, 10.87]; p = 0.543). BA length was associated with age in South Asians (+0.34 mm/year [0.02; 0.65]; p = 0.037) and African Caribbeans (+0.39 mm/year [0.12; 0.65]; p = 0.005) but not Europeans (+0.08 mm/year [−0.26; 0.41]; p = 0.653). BA diameter (rho = 0.210; p = 0.022) and length (rho = 0.261; p = 0.004) were associated with frontal WMH load in South Asians (persisting after multivariable adjustment for CVRF).
Conclusions
Compared with Europeans, the basilar artery undergoes more accelerated EVA in South Asians and in African Caribbeans, albeit to a lesser extent. Such EVA may contribute to the higher burden of CSVD observed in South Asians and excess risk of stroke, vascular cognitive impairment and dementia observed in these ethnic groups.
... 6 Comparatively few data are available for Americans of Asian or Hispanic background. [7][8][9][10][11] Additionally, some of the available brain MRI data were collected 10 to 25 years ago, and newer MRI protocols provide improved image resolution and quantification. ...
Background
Cardiovascular risk factors are associated with cognitive decline and dementia. Magnetic resonance imaging provides sensitive measurement of brain morphology and vascular brain injury. However, associations of risk factors with brain magnetic resonance imaging findings have largely been studied in White participants. We investigated associations of race, ethnicity, and cardiovascular risk factors with brain morphology and white matter (WM) injury in a diverse population.
Methods and Results
In the Multi‐Ethnic Study of Atherosclerosis, measures were made in 2018 to 2019 of total brain volume, gray matter and WM volume, and WM injury, including WM hyperintensity volume and WM fractional anisotropy. We assessed cross‐sectional associations of race and ethnicity and of cardiovascular risk factors with magnetic resonance imaging measures. Magnetic resonance imaging data were complete in 1036 participants; 25% Black, 15% Chinese‐American, 19% Hispanic, and 41% White. Mean (SD) age was 72 (8) years and 53% were women. Although WM injury was greater in Black than in White participants in a minimally adjusted model, additional adjustment for cardiovascular risk factors and socioeconomic status each attenuated this association, rendering it nonsignificant. Overall, greater average WM hyperintensity volume was associated with older age and current smoking (69% greater vs never smoking); lower fractional anisotropy was additionally associated with higher diastolic blood pressure, use of antihypertensive medication, and diabetes.
Conclusions
We found no statistically significant difference in measures of WM injury by race and ethnicity after adjustment for cardiovascular risk factors and socioeconomic status. In all racial and ethnic groups, older age, current smoking, hypertension, and diabetes were strongly associated with WM injury.
