Subcortical Arteriosclerotic Encephalopathy Research Articles

First seizure in elderly patients: Need to treat? Evidence from a retrospective study

BackgroundThe risk of seizure recurrence after a first unprovoked epileptic seizure is reported to be approximately 40%. Little is known about the recurrence risk after a first seizure in elderly patients, who may be at higher risk due to an increased rate of structural lesions, encephalopathy, subcortical arteriosclerotic encephalopathy or brain atrophy.MethodsIn a retrospective approach, the recurrence rate in 304 patients aged 60 years and above who presented with a first seizure between 2004 and 2017 was analyzed. Hierarchical Cox regression was used to investigate the impact of EEG and neuroimaging results, age or the prescription of anti-seizure medication (ASM) on seizure recurrence.ResultsSeizure recurrence rates were 24.5% and 34.4% after one and two years, respectively. Anti-seizure medication was started in 87.8% of patients, in 28.8% despite the absence of clear epileptogenic lesions on neuroimaging or epileptiform potentials in the EEG. Medical treatment significantly reduced the risk of recurrence (hazard ratio = 0.47). Epileptiform potentials in the EEG, epileptogenic lesions in neuroimaging and age had no significant effect on seizure recurrence. Age and the presence of neurodegenerative and psychiatric comorbidities showed a significant association with ASM prescription.ConclusionsThe present data show a strong protective effect of ASM on seizure recurrence in patients above the age of 60, even in the absence of pathologic neuroimaging or EEG results needed for the diagnosis of epilepsy. Treatment with ASM therefore seems beneficial for reducing the recurrence risk in elderly patients. The lack of a significant association between seizure recurrence and epileptogenic lesions might be related to other confounding factors like encephalopathy, subcortical arteriosclerotic encephalopathy, neurodegenerative diseases or brain atrophy.

An exploratory study of delayed flash visual evoked potential P2 wave latency in subcortical arteriosclerotic encephalopathy

BackgroundPatients with cognitive dysfunction may present with significantly prolonged the P2 wave latency of flash visual evoked potential. However, no studies have been reported on whether the P2 wave latency of flash visual evoked potential is prolonged in patients with subcortical arteriosclerotic encephalopathy (SAE).ObjectiveTo examine the relationship between flash visual evoked potential P2 wave latency (FVEP-P2 wave latency) and cognitive impairment in patients with SAE.MethodsOverall, we recruited 38 SAE patients as the observation cohort (OC) and 34 healthy volunteers as the control cohort (CC). We measured the FVEP-P2 wave latency for both groups. The SAE patients’ cognitive abilities were evaluated via mini-mental state examination (MMSE) and the association between the latency of FVEP-P2 and MMSE score was explored by Pearsons´s correlation test.ResultsThere is no significant difference between OC (21 males and 17 females; 68.6 ± 6.7 years of age and 9.6 ± 2.8 years of education) and CC (19 males and 15 females; 65.3 ± 5.9 years of age and 10.1 ± 2.6 years of education) in gender and age composition and education level. The FVEP-P2 wave latency of the CC group was (108.80 ± 16.70) ms and the OC FVEP-P2 wave latency was (152.31 ± 20.70) ms. The OC FVEP-P2 wave latency was significantly longer than the CC (P < 0.05). In terms of MMSE scores, the MMSE scores of CC was (28.41 ± 2.34), and that of OC was (9.08 ± 4.39). Compared to the CC, the OC MMSE score was significantly lower (P < 0.05). In addition, the FVEP-P2 wave latency was inversely related to the MMSE (r = -0.4465, P < 0.05) in SAE patients.ConclusionThe FVEP-P2 wave latency wave latency was significantly prolonged in SAE patients and strongly associated with the degree of cognitive dysfunction.

Study on the Features of Clinical Imaging Diagnosis of Arteriosclerotic Encephalopathy.

This paper discusses the imaging diagnostic features of arteriosclerotic encephalopathy and combines the spatial context information of local features to study the clinical imaging image copy detection algorithm. Moreover, this paper proposes a clinical imaging copy detection algorithm that combines the BOW model and spatial context embedding and a clinical imaging copy detection algorithm that combines the BOW model and global context verification. In addition, this paper applies the algorithm to the imaging diagnostic features of arteriosclerotic encephalopathy and sets up a controlled experiment to start research. The experimental research shows that the application of imaging diagnosis to the detection of subcortical arteriosclerotic encephalopathy has good clinical effects and rapid remission of patients' symptoms. The effectiveness of this method can be verified by a large number of clinical practices in follow-up studies.

Binswanger disease: Pathomorphology of cognitive impairment and dementia

Binswanger disease or subcortical arteriosclerotic encephalopathy refers to slowly progressive white-matter vascular dementia. Patients usually present symptoms including forgetfulness, personality and emotional changes. The aim of this study was to investigate the neuropathological substrates of cognitive impairment and dementia in Binswanger disease for the reliability of the diagnosis.

Clinical and neuroimaging features of chronic cerebral ischemia in polycythemia vera

The purpose of the study. To study clinical and neuroimaging features of chronic cerebral ischemia (CCI) in polycythemia vera (PV).Materials and methods. 66 patients with PV were examined – the main group (43 men, 23 women; mean age 62.0 ± 3.4 years), of which 64 (97.0%) patients were diagnosed with CCI. The comparison group consisted of 85 patients with CCI (34 men, 51 women; mean age 67.7 ± 4.6 years), who developed against the background of cerebral vascular atherosclerosis and arterial hypertension. To identify cognitive disorders, we used Mini Mental State Examination (MMSE). Insomnia was studied in accordance with the criteria of the International Classification of Sleep ICDS‑22005. The quality of sleep was determined using a questionnaire from the Federal Somnological Center. Neuroimaging (MRI of the brain) was performed on Siemens Symphony 1.5 T and GE Signa 1.5 T tomographs.Results. Subjective symptoms CCI are characterized by a greater representation of asthenic and insomniac disorders. Transient ischemic attacks in patients with PV are significantly more common than in the comparison group, their frequency depends on the duration of PV. The revealed changes in MRI of the brain in the majority of PV patients with CCI are characteristic of multiinfarction vascular encephalopathy; in the comparison group, changes that characteristic for subcortical arteriosclerotic encephalopathy were more often recorded.

EEG Synchronization-Parameters in Patients With Subcortical Arteriosclerotic Encephalopathy and Gait Disorder.

Subcortical arteriosclerotic encephalopathy (SAE) is characterized by extensive white matter lesions in the MRI. Clinical symptoms are cognitive impairment, ranging from mild deficits to vascular dementia, impaired executive functioning, and gait disorders. In the EEG of SAE patients with vascular dementia, the lower frequencies are increased. However, it is unclear whether EEG changes also exist in SAE patients with gait disorders but without vascular dementia. The authors analyzed the EEGs of 50 nondemented patients with SAE and gait disorders and 50 healthy controls applying pointwise transinformation as a measure of synchronization. Hundred seconds of waking EEG that appeared unaltered in visual analysis were sufficient to prove changes in synchronization. The authors found a decrease in the mean level of synchronization, combined with an elongation of synchronization time in all examined brain areas. These effects correlated slightly with the extent of subcortical lesions. Changes in EEG synchronization in patients with SAE and gait disorders seem to occur independently of cognitive function. The causal relationship of the changes in EEG synchronization and gait disorders remains to be clarified. The results of this study might point to a decrease in coupling efficiency in these patients, with the increase in synchronization duration as a possible compensatory mechanism. Because a time-efficient signal transmission particularly during gait execution is crucial, reduced efficiency might contribute to an impairment of postural stabilization. The study results might indicate a neuronal network for planning and execution of motor activity and particularly gait, extending from the frontal over the central to the parietal cortex.

Analysis of the correlation between thyroid function and cognitive function ients with subcortical arteriosclerotic encephalopathy

Objective To explore the correlation between thyroid function and cognitive ability in patients with subcortical arteriosclerotic encephalopathy. Methods Montreal cognitive assessment scale (Montreal Cognitive Assessment, MoCA) was used to evaluate the cognitive function of SAE patients with normal thyroid function and hypothyroidism.And the difference in the risk factors of SAE cognitive ability in patients with different thyroid functions was analyzed. Results There were no significant differences in gender, age, risk factors of hypertension, cerebral infarction, diabetes and smoking between the two groups (P>0.05). The levels of FT3, FT4, TSH, MoCA and ADL in patients with hypothyroidism were (2.92±0.35)pmol/L, (15.61±2.76)pmol/L, (13.05±1.64) mU/L, (12.73±5.75)points, (45.64±25.77)points, respectively.The levels of FT3, FT4 and TSH in normal thyroid function group and MoCA, ADL scores were (4.27±0.55)pmol/L, (16.74±2.35)pmol/L, (2.73±0.38) mU/L, (18.15±5.35)points, (62.17±26.72)points, respectively.The data of the hypothyroidism group was significantly lower than thst in the normal thyroid function group, and the difference was statistically significant (t=3.591, 3.012, 12.753, 8.967, 15.442, P<0.05). FT3 levels in SAE patients were positively correlated with MoCA score and ADL score (r=0.518, 0.617, P=0.026, 0.018), while there was no significant correlation between FT4 level and MoCA and ADL score (r=0.015, 0.007, P=0.852, 0.074). MoCA score and ADL score were negatively correlated with TSH level (r=-0.651, -0.582, P=0.016, 0.005). Conclusion Thyroid function is significantly correlated with cognitive ability of SAE patients.Thyroid function may be a clinical index for patients with subcortical arteriosclerosis, and provide a basis for rational drug use in patients with subcortical arteriosclerosis. Key words: Thyroid function; Subcortical arteriosclerotic encephalopathy; Cognitive dysfunction

Imaging features in conventional MRI, spectroscopy and diffusion weighted images of hereditary diffuse leukoencephalopathy with axonal spheroids (HDLS)

Hereditary diffuse leukoencephalopathy with axonal spheroids (HDLS) is a rare autosomal dominant disease caused by mutations within the colony stimulating factor 1 receptor (CSF1R) gene. While a small number of reports on imaging findings in routine MRI exist, reported imaging findings in DWI and spectroscopy are scarce, and limited to not genetically proven case reports. We assessed MRI including DWI and MR spectroscopy in six patients with HDLS and two asymptomatic mutation carriers. A total of 13 MRIs were evaluated and a score of the white-matter lesion (WML) load was calculated. The course of MR abnormalities was followed for 6-19 months in four patients and 95 months in one carrier. MRI revealed widespread white-matter lesions of patchy or confluent pattern especially in the frontal and occipital lobe. The pyramidal tract was less affected than the surrounding tissue in all symptomatic patients on conventional T2WI. Three of four cases with DWI showed small dots of diffusion restriction within WML. Spectroscopy showed increased levels of mIns, Cho and lactate while NAA was decreased. Asymptomatic mutation carriers had, for the age of the patients, unusually pronounced unspecific WMLs. No diffusion restriction or alterations in metabolite levels could be detected in asymptomatic mutation carriers. Microbleeds were not found in any patient. Diffusion restriction seems to be a typical imaging pattern visible in patients with active disease progression in HDLS. Spectroscopic findings and the absence of microbleeds differ clearly from reported findings in CADASIL and subcortical arteriosclerotic encephalopathy. While the distribution and character of WMLs in asymptomatic cases remain unspecific they are likely to represent subclinical markers of HDLS.

Postural Vertigo in Older Persons

Many thanks for the informative article on innovations in the area of vestibular types of vertigo. I was merely baffled on reading “bilateral vestibulopathy … is the most frequent cause of motion-dependent postural vertigo in older patients.” How, and when, should one diagnostically evaluate potential bilateral vestibulopathy in patients with pallhypesthesia, a total hip or knee endoprosthesis, visual impairments, and subcortical arteriosclerotic encephalopathy? At this point I—and probably many other readers—would appreciate additional advice.

How far can the radiation dose be lowered in head CT with iterative reconstruction? Analysis of imaging quality and diagnostic accuracy

To evaluate the imaging quality of head CT at lowered radiation dose by combining filtered back projection (FBP) and iterative reconstruction (IR) algorithms. Experimental group A (n = 66) underwent CT with 43% tube current reduction, and group B (n = 58) received an equivalent reduced dose by lowering the tube voltage. An age- and sex-matched control group (n = 72) receiving the conventional radiation dose was retrospectively collected. Imaging for the control group was reconstructed by FBP only, while images for groups A and B were reconstructed by FBP and IR. The signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), sharpness, number of infarcts and severity of subcortical arteriosclerotic encephalopathy (SAE) were compared to assess imaging quality and diagnostic accuracy. There were no significant differences in SNRs and CNRs between group A and the control group. There were significantly decreased SNRs and increased CNRs in group B. Image sharpness decreased in both groups. Correlations between detected infarcts and severity of SAE across FBP and IR were high (r = 0.73-0.93). Head diameter was the only significant factor inversely correlated with infratentorial imaging quality. Head CT with 43% reduced tube current reconstructed by IR provides diagnostic imaging quality for outpatient management. • Cranial CT using iterative reconstruction provides diagnostic images with 43% mAs reduction. • Blurring of infratentorial images becomes evident using low-radiation head CT. • Head diameter was inversely correlated with imaging quality in the infratentorium. • Lowering tube kilovoltage requires a higher radiation dose to maintain image quality.

Impact of subcortical white matter lesions on dopamine transporter SPECT

Subcortical arteriosclerotic encephalopathy (SAE) can affect the nigrostriatal system and presumably cause vascular parkinsonism (VP). However, in patients with SAE, the differentiation of VP from idiopathic Parkinson's disease (IPS) is challenging. The aim of the present study was to examine the striatal dopamine transporter (DAT) density in patients with parkinsonism and SAE. Fifteen consecutive patients with parkinsonian symptoms displayed SAE, as detected by magnetic resonance imaging (MRI). Fifteen retrospectively chosen, matched patients with diagnosis of IPS without any abnormalities in MRI served as a reference group. DAT SPECT was performed using the tracer ¹²³I-FP-CIT. Scans were acquired on a triple-head SPECT system (Multispect 3, Siemens) and analysed using the investigator-independent BRASS™ software (HERMES). In the SAE group, a DAT deficit was observed in 9/15 patients. In contrast, all patients from the IPS group showed a reduced DAT binding (p = 0.008). The specific binding ratios (BR) of putamen contralateral to the side of the more affected limb versus occipital lobe were in trend higher in patients with SAE versus patients in the IPS-group (p = 0.053). Indices for putaminal asymmetry (p = 0.036) and asymmetry caudate-to-putamen (p = 0.026) as well as the ratio caudate-to-putamen (p = 0.048) were significantly higher in IPS patients having no SAE. DAT deficit was less pronounced in patients with SAE and parkinsonism than in patients with IPS without any abnormalities in the MRI. A potential role of DAT SPECT in the differential diagnosis of VP and IPS requires more assessments within prospective studies.

Dyscirculatory encephalopathy: algorithm for diagnosis and treatment in patients with arterialhypertension

The paper analyzes clinic symptomatology and an algorithm for diagnosis, preventive and syndromic treatment, and rehabilitation in patients with different forms of hypertensive dyscirculatory encephalopathy, such as subcortical arteriosclerotic encephalopathy and hypertensive multi-infarct encephalopathy.

Prevalence and Pathology of Vascular Dementia in the Oldest-Old1

The prevalence of both Alzheimer's disease (AD) and vascular dementia (VaD) increase with advancing age, but epidemiologic data above age 85 are imprecise and inconsistent. A retrospective hospital-based study of the prevalence and pathology of VaD was performed in 1700 consecutive autopsy cases of demented elderly in Vienna, Austria (mean age 84.3 ± 5.4 SD; 90% over age 70). It assessed clinical and general autopsy data and neuropathology including immunohistochemistry. Neuropathologic diagnosis followed current consensus criteria. Four age groups (7th to 10th decade) were evaluated. "Pure" VaD (due to cerebrovascular disease without other pathologies; neuritic Braak stages 1.2-1.6) was observed in 12.3% of the total cohort, decreasing between age 60 and 90+ from 15.0 to 8.7%. Morphologic subtypes (subcortical arteriosclerotic encephalopathy, multi-infarct encephalopathy, and strategic infarct dementia) showed no age-related differences. By contrast, AD (without concomitant pathologies; 45.6% of total), mixed dementia (AD + cerebrovascular encephalopathy; 5.5%), and AD with minor cerebrovascular lesions (22.3%) increased with age. The relative prevalence of AD + Lewy pathology (9.3%) remained fairly stable, whereas other dementias (5.0%) decreased significantly over age 90. 85% of the patients with "pure" VaD had histories of diabetes, 75% of stroke(s), 95% morphologic signs of hypertension, 65% myocardial infarction (recent and old ones), 97% cerebral hypertonic-arteriosclerotic microangiopathy (associated with cerebral amyloid angiopathy in 23%) and 90% severe atherosclerosis of large cerebral arteries. Similar autopsy findings were seen in mixed dementia (MIX) and in AD + minor cerebrovascular lesions. Major vascular lesions differed between VaD and MIX, VaD showing more than 60% subcortical infarcts, MIX only 43% such lesions. This retrograde hospital-based study using strict morphologic diagnostic criteria confirmed the existence of "pure" VaD in old age, with a tendency to decline after age 90, while AD and AD + cerebrovascular pathologies showed considerable age-related increase, and "pure" AD slightly decreasing after age 90.

Intracranial MR Dynamics in Clinically Diagnosed Alzheimers Disease: The Emerging Concept of &amp;#x201C;Pulse Wave Encephalopathy&amp;#x201D;

As increasingly shown in neuropathological and predementia clinical studies, cognitive decline with altered intracranial dynamics can fulfill current clinical criteria of dementia of the Alzheimer's type (DAT) and there is a marked pathogenic complexity of this epidemic syndrome. Whereas structural studies only suggest the unexpected frequency of cerebrovascular changes in late life DAT, flow quantification MR sequences now offer a great opportunity of in vivo accurate analysis of cerebrovascular function. Their first applications have allowed development of a modern concept of the intracranial dynamics; a complex windkessel system allows two processes that are crucial to insure brain oxygenation and nutrition, a periodic systolic marked expansion of the intracranial blood compartment within the rigid cranial cavity on the one hand, a marked dampening of the arterial pulse wave before it reaches capillary level on the other hand. This modern concept has allowed better understanding of two archetypes of windkessel failure or so-called pulse wave encephalopathy, normal pressure hydrocephalus and subcortical arteriosclerotic encephalopathy. Dynamic MRI may now help to detect and classify distinct patterns of cerebrovascular dysfunction in DAT. This dynamic approach helps to understand the major association between aging and DAT as well as the increasingly recognized overlap between Alzheimer's pathology, normal pressure hydrocephalus and arteriosclerotic neurodegeneration. Evidence of such a great variety of disturbances in intracranial dynamics behind a single clinical syndrome of DAT can greatly impact therapeutic research on this devastating disorder.

Leukoaraiosis: From an Ancient Term to an Actual Marker of Poor Prognosis

See related article, pages 1409–1413. The term leukoaraiosis (from the Greek leuko , white, and araiosis , rarefaction) was introduced in 1986 by Hachinski, Potter and Merskey to designate bilateral and symmetrical areas in the periventricular and centrum semiovale white matter that appeared hypodense on CT scans and hyperintense on T2-weighted MRI.1,2 Leukoaraiosis was supposed to be “a neutral term, exact enough to define white-matter changes, sufficient as a description or label, and demanding enough to require precise clinical and imaging descriptions.”1,2 It was clear in Hachinski and coworkers’ proposal the aim of contrasting the tendency to immediately identify a radiological aspect with a clinical picture. At that time, changes or lesions of the white matter were recognized with increasing frequency on the brain CT scans of elderly patients,3 and some authors had begun to attribute a clinical significance to these radiological findings, particularly interpreting them as a correlate of cognitive decline. According to some, the introduction of CT had made possible the identification in vivo of subcortical arteriosclerotic encephalopathy (or Binswanger disease), a form of vascular dementia with only few cases reported on pathological grounds until the eighties.4,5 The issue became even more complex after the introduction of MRI in neurological clinical practice because it was soon apparent …

CSF biomarkers in the evaluation of idiopathic normal pressure hydrocephalus

BACKGROUND - To evaluate cerebrospinal fluid (CSF) markers for neuronal degeneration and demyelination in idiopathic normal pressure hydrocephalus (INPH), subcortical arteriosclerotic encephalopathy (SAE), and neurologically healthy subjects. METHODS - Lumbar CSF concentrations of sulfatide, neurofilament protein light (NFL), total-tau (T-tau), hyperphosphorylated tau (P-tau), and beta-amyloid(1-42) (Abeta42) were analyzed in 62 INPH patients, 26 SAE patients, and 23 neurologically healthy controls. In INPH patients, samples before and after shunt surgery were analysed. RESULTS - The CSF concentration of NFL was elevated in INPH and SAE compared with the controls, and levels of T-tau, P-tau, and Abeta42 were lower in INPH compared with SAE and controls. No difference was seen for sulfatide. All markers except Abeta42 were significantly elevated after shunt surgery. CONCLUSIONS - The most striking finding was the power of the combined pattern of NFL, P-tau, and Abeta42 in distinguishing between the clinical diagnoses of INPH, SAE, and neurologically healthy elderly.

Regional cerebral blood flow and blood volume in patients with subcortical arteriosclerotic encephalopathy (SAE)

The aim of the present study was a detailed analysis of the regional cerebral blood flow and blood volume in patients with subcortical arteriosclerotic encephalopathy (SAE) by means of functional magnetic resonance imaging (MRI). A group of 26 patients with SAE and a group of 16 age-matched healthy volunteers were examined. Using a well-established dynamic susceptibility contrast-enhanced MRI method, the regional cerebral blood flow (rCBF) and blood volume (rCBV) were quantified for each subject in 12 different regions in the brain parenchyma. As compared to healthy volunteers, patients with SAE showed significantly reduced rCBF and rCBV values in white matter regions and in the occipital cortex. Regions containing predominantly grey matter show almost normal rCBF and rCBV values. In conclusion, quantitative analysis of rCBF and rCBV values demonstrates clearly that SAE is a disease that is associated with a reduced microcirculation predominantly in white matter.

Das vaskuläre Parkinson-Syndrom

The present review shows that vascular parkinsonian syndrome (VPS) fulfilling stringent diagnostic criteria for parkinsonism is a rare disease that cannot always be distinguished from neurodegenerative parkinsonism on clinical grounds. Thus VPS needs to be differentiated from other disturbances, which have distinct phenomenological and therapeutical features including isolated gait disturbances associated with subcortical arteriosclerotic encephalopathy and neurodegenerative parkinsonism complicated by comorbid vascular encephalopathy. Acute or subacute VPS is usually caused by contralateral infarctions involving the external globus pallidus, ventrolateral thalamus, and, less often, the substantia nigra. Chronic VPS with insidious onset is related to bilateral subcortical infarctions affecting thalamocortical projections. Differentiation from degenerative parkinsonism is difficult in cases of VPS that display a progressive course and response to levodopa.

Secondary Mania in Older Adults

Although mania is commonly associated with bipolar disorder, it can have many etiologies (1). Thus, “primary mania” results from bipolar disorder, whereas “secondary mania” results from pharmacological, metabolic, or neurologic causes (1, 2). Older adults are at risk for secondary mania because of increased medical comorbidities and neurological changes. In one retrospective study of 50 patients with mania who were older than 65 years, it was the first manic episode for 28% of the patients and 71% had a comorbid neurological disorder (3). The etiology of mania is important because although acute symptomatic treatment of both primary and secondary mania may be similar, appropriate treatment of secondary mania includes addressing the cause (1). We present here two case histories of secondary mania in older adults, discuss their presentations and differential diagnosis in turn, and discuss treatment.

Mental disorders in Binswanger's disease

Subcortical arteriosclerotic encephalopathy, or Binswanger's disease (BD), is a special form of chronic progressive vascular disease of the brain, the main clinical manifestation of which is dementia in combination with a variety of neurological symptoms (subcortical, cerebellar, pseudobulbar and pyramidal syndromes and disorders of other pelvic organs) .). The genesis of the disease, primarily dementia syndrome, is based on diffuse lesion of the white matter (BV) of the cerebral hemispheres, caused by severe arteriosclerosis of the blood vessels supplying it.