Subcortical Vascular Lesions Research Articles

BrainPath Tubular Retractor System for Subcortical Hemorrhagic Vascular Lesions: A Case Series of Technique and Outcomes

BACKGROUND AND OBJECTIVES: Hemorrhagic subcortical vascular lesions such as cavernous malformations (CM) and arteriovenous malformations (AVM) can be neurologically devastating. Conventional open surgical resection is often associated with additional morbidity. The BrainPath® (NICO Corp.) transsulcal tubular retractor system offers a less-invasive corridor to deep-seated lesions. Our objective was to describe a single-center experience with the resection of subcortical hemorrhagic vascular lesions in adult and pediatric patients using the BrainPath® system. METHODS: The departmental database was queried for patients who underwent resection of a hemorrhagic CM, AVM, or cerebral aneurysm through the BrainPath® tubular retractor system between January 2017 and September 2021. All patients underwent either postoperative MRI (for patients with CM) or digital subtraction angiography (for patients with AVM or aneurysm). Demographic and clinical characteristics, preoperative and postoperative imaging features, operative details, and surgical and clinical outcomes were extracted through a retrospective review of the medical records. RESULTS: Fourteen patients (mean [SD] age 32.3 [23.9] years; 7 (50%) female) underwent BrainPath®-based resection of a deeply seated CM (n = 7), AVM (n = 6), or ruptured cerebral aneurysm (n = 1). The mean maximal lesion diameter was 21.5 (12.6) mm. The mean operative time was 134 (53) minutes. Residual lesion was present in 2 patients, both of which underwent repeat BrainPath®-assisted surgery for complete resection. All lesions were completely resected or obliterated on postoperative MRI or digital subtraction angiography. At a mean follow-up of 4.1 (1.1) years, the median modified Rankin Scale score was 1 (range 0-6). CONCLUSION: In a well-selected cohort, we show the effective use of BrainPath® tubular retractors for resection or obliteration of subcortical hemorrhagic vascular lesions. This report further exemplifies the expanded role of the endoport system beyond that of intracerebral hemorrhage and tumor. Further study will elucidate the impact of this less-invasive brain retraction technique on clinical outcome in patients with vascular lesions.

Parietal resting-state EEG alpha source connectivity is associated with subcortical white matter lesions in HIV-positive people

ObjectiveParietal resting-state electroencephalographic (rsEEG) alpha (8–10 Hz) source connectivity is abnormal in HIV-positive persons. Here we tested whether this abnormality may be associated with subcortical white matter vascular lesions in the cerebral hemispheres. MethodsClinical, rsEEG, and magnetic resonance imaging (MRI) datasets in 38 HIV-positive persons and clinical and rsEEG datasets in 13 healthy controls were analyzed. Radiologists visually evaluated the subcortical white matter hyperintensities from T2-weighted FLAIR MRIs (i.e., Fazekas scale). In parallel, neurophysiologists estimated the eLORETA rsEEG source lagged linear connectivity from parietal cortical regions of interest. ResultsCompared to the HIV participants with no/negligible subcortical white matter hyperintensities, the HIV participants with mild/moderate subcortical white matter hyperintensities showed lower parietal interhemispheric rsEEG alpha lagged linear connectivity. This effect was also observed in HIV-positive persons with unimpaired cognition. This rsEEG marker allowed good discrimination (area under the receiver operating characteristic curve > 0.80) between the HIV-positive individuals with different amounts of subcortical white matter hyperintensities. ConclusionsThe parietal rsEEG alpha source connectivity is associated with subcortical white matter vascular lesions in HIV-positive persons, even without neurocognitive disorders. SignificanceThose MRI-rsEEG markers may be used to screen HIV-positive persons at risk of neurocognitive disorders.

Linking cortical atrophy to white matter hyperintensities of presumed vascular origin

We examined the relationship between white matter hyperintensities (WMH) and cortical neurodegeneration in cerebral small vessel disease (CSVD) by investigating whether cortical thickness is a remote effect of WMH through structural fiber tract connectivity in a population at increased risk of CSVD. We measured cortical thickness on T1-weighted images and segmented WMH on FLAIR images in 930 participants of a population-based cohort study at baseline. DWI-derived whole-brain probabilistic tractography was used to define WMH connectivity to cortical regions. Linear mixed-effects models were applied to analyze the relationship between cortical thickness and connectivity to WMH. Factors associated with cortical thickness (age, sex, hemisphere, region, individual differences in cortical thickness) were added as covariates. Median age was 64 [IQR 46–76] years. Visual inspection of surface maps revealed distinct connectivity patterns of cortical regions to WMH. WMH connectivity to the cortex was associated with reduced cortical thickness (p = 0.009) after controlling for covariates. This association was found for periventricular WMH (p = 0.001) only. Our results indicate an association between WMH and cortical thickness via connecting fiber tracts. The results imply a mechanism of secondary neurodegeneration in cortical regions distant, yet connected to subcortical vascular lesions, which appears to be driven by periventricular WMH.

Latent Cognitive Profiles Differ Between Incipient Alzheimer's Disease and Dementia with Subcortical Vascular Lesions in a Memory Clinic Population.

It is unclear if latent cognitive profiles can distinguish between dementia with subcortical vascular lesions and Alzheimer's disease (AD) at the incipient stage, and if they differ in performance from the Petersen subtypes. To identify latent cognitive profiles in a naturalistic population of patients from a memory clinic sample, and investigate the derived classes not only in terms of conversion to AD, but also in terms of conversion to dementia with subcortical vascular lesions. Another objective was to compare the derived classes to the Petersen subtypes. We performed a latent profile analysis (LPA) on standardized neuropsychological test scores from 476 memory clinic patients (age 64±8) without dementia, and analyzed progression to dementia after 2 years. The LPA resulted in two classes with impaired cognition (Amnestic and Slow/Dysexecutive) and two classes with normal cognition (Normal-Low and Normal-High cognition). Belonging to the Amnestic class predicted progression to all-cause dementia and to AD; belonging to the Slow/Dysexecutive class predicted progression to all-cause dementia, AD, and dementia with subcortical vascular lesions. Of the Petersen MCI subtypes, only amnestic multi-domain MCI predicted progression to all-cause dementia, AD, and dementia with subcortical vascular lesions. Latent cognitive profiles separated between AD and dementia with subcortical vascular lesions, while the Petersen subtypes did not. However, similar to the Petersen subtypes, LPA classes work better for ruling out progression to dementia than for case finding.

Use of Tubular Retractor for Resection of Deep-Seated Cerebral Tumors and Colloid Cysts: Single Surgeon Experience and Review of the Literature.

Brain retraction is often required to develop a surgical corridor during the resection of deep-seated intracranial lesions. Traditional blade retractors distribute pressure asymmetrically and may case local tissue damage. Tubular retractors minimize this pitfall by distributing pressure evenly, which has been shown to translate to significant safety and efficacy data. Further qualified reports regarding the use of tubular retractors are of interest. We performed a retrospective analysis of 1 surgeon's experience with 20 cases of minimally invasive resection with the ViewSite Brain Access System (n= 7) and BrainPath (n= 13) systems. In addition, a comprehensive review of all published cases of tubular retractor systems used for resection of subcortical neoplastic, cystic, infectious, vascular, and hemorrhagic lesions was conducted. Of the 20 cases analyzed, gross total resection was achieved in 18, with an associated 10% immediate postoperative complication rate and 5% long-term complication rate. A comprehensive review of the literature showed 30 articles describing 536 cases of resection of deep neoplastic or colloid cysts with an overall complication rate of 9.1%. Tubular retractor systems have a favorable safety profile and are an important tool in the armamentarium of a neurosurgeon for the resection of deep intracranial lesions.

ID 252 – Auditory startle reflex (ASR) in ischemic and hemorrhagic stroke

Objective To evaluate the influence of cortical and subcortical vascular lesions on ASR. Methods We studied in 16 patients (9 middle cerebral artery (MCA) lesions and 7 basal ganglia hematoma (BGH)): ASR, MEP, cortical silent period, H reflex and Fugl-Meyer and Ashworth scale. Six were evaluated in the acute phase, 6 in subacute and chronic phases and 4 in both. Results Four of 5 BGH patients evaluated in the acute phase had an absent ASR and one responded only on the clinically spared side. On the contrary, four of 5 MCA patients evaluated in the acute phase presented an increased biceps response on the clinically affected side (CAS). In subacute and chronic phases 3 of 5 MCA and 4 of 5 BGH patients developed enhanced biceps responses on the CAS. Conclusions Enhanced ASR in vascular lesions can be due to a loss of the inhibitory hemispheric or basal ganglia drive on ASR generators. The absence of ASR in the acute phase of BGH could suggest a transient hypofunction of brainstem structures. Key message Ischemic stroke can be associated with an increased ASR on the CAS and BGH with an absent ASR in the acute phase, which is enhanced in subacute and chronic phases.

Correlation between Motor Cortex Excitability Changes and Cognitive Impairment in Vascular Depression: Pathophysiological Insights from a Longitudinal TMS Study.

Background. Transcranial magnetic stimulation (TMS) highlighted functional changes in dementia, whereas there are few data in patients with vascular cognitive impairment-no dementia (VCI-ND). Similarly, little is known about the neurophysiological impact of vascular depression (VD) on deterioration of cognitive functions. We test whether depression might affect not only cognition but also specific cortical circuits in subcortical vascular disease. Methods. Sixteen VCI-ND and 11 VD patients, age-matched with 15 controls, underwent a clinical-cognitive, neuroimaging, and TMS assessment. After approximately two years, all participants were prospectively reevaluated. Results. At baseline, a significant more pronounced intracortical facilitation (ICF) was found in VCI-ND patients. Reevaluation revealed an increase of the global excitability in both VCI-ND and VD subjects. At follow-up, the ICF of VCI-ND becomes similar to the other groups. Only VD patients showed cognitive deterioration. Conclusions. Unlike VD, the hyperfacilitation found at baseline in VCI-ND patients suggests enhanced glutamatergic neurotransmission that might contribute to the preservation of cognitive functioning. The hyperexcitability observed at follow-up in both groups of patients also indicates functional changes in glutamatergic neurotransmission. The mechanisms enhancing the risk of dementia in VD might be related either to subcortical vascular lesions or to the lack of compensatory functional cortical changes.

The overlap between vascular disease and Alzheimer's disease--lessons from pathology.

Recent epidemiological and clinico-pathological data indicate considerable overlap between cerebrovascular disease (CVD) and Alzheimer’s disease (AD) and suggest additive or synergistic effects of both pathologies on cognitive decline. The most frequent vascular pathologies in the aging brain and in AD are cerebral amyloid angiopathy and small vessel disease. Up to 84% of aged subjects show morphological substrates of CVD in addition to AD pathology. AD brains with minor CVD, similar to pure vascular dementia, show subcortical vascular lesions in about two-thirds, while in mixed type dementia (AD plus vascular dementia), multiple larger infarcts are more frequent. Small infarcts in patients with full-blown AD have no impact on cognitive decline but are overwhelmed by the severity of Alzheimer pathology, while in early stages of AD, cerebrovascular lesions may influence and promote cognitive impairment, lowering the threshold for clinically overt dementia. Further studies are warranted to elucidate the many hitherto unanswered questions regarding the overlap between CVD and AD as well as the impact of both CVD and AD pathologies on the development and progression of dementia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0206-2) contains supplementary material, which is available to authorized users.

Abstract T P360: Risk Factors Underlying Recurrent Subclinical Subcortical Cerebrovascular Lesions in Elderly Patients

Background and Purpose: Subclinical subcortical cerebrovascular lesions (SSCLs) are very common in elderly people. Accumulation of SSCLs may have additive or even synergic effects to the coexisting brain lesions such as Alzheimer’s pathology or symptomatic cerebrovascular lesions in elderly patients, but the mechanisms underlying the recurrence of SSCLs remains to be clarified. The present study was conducted to elucidate the contributing risk factors to the recurrent SSCLs. Subjects and Methods: The present study was based on 96 cases (55 men and 41women) with subcortical lesions, including 49 cases with symptomatic lacunar infarction, 36 cases with asymptomatic lacunar infarction, and 11 cases with symptomatic intracerebral hemorrhage. The mean age was 70.9 years. MRI studies were repeated with an average interval of 416 (248-822) days. Numbers of lacunar infarcts (LIs) and microbleeds (MBs) were counted in all MR slices, and the degree of white matter lesions (WMLs) was evaluated according the Fazekas’ categories, and those parameters were compared between the baseline and follow-up images. Laboratory studies included high sensitivity CRP (hsCRP), interleukin-6 (IL-6), serum lipid profile, glucose and brain natriuretic peptide (BNP). Results: The number of LIs increased in 16 cases whereas unchanged in 80 cases. The number of MBs increased in 16 cases, whereas unchanged in 80 cases. There was a deterioration in the degree of WMLs in 7 cases, whereas no change in 89 cases. Those with recurrent LIs had significantly greater number of LIs in the baseline MRI (p<0.005), and those with recurrent MBs had greater numbers of LIs and MBs at baseline MRI (p<0.005). Those who showed deterioration in WMLs had greater number of MBs and higher total cholesterol, LDL-cholesterol and lower HDL-cholesterol at baseline. Six cases showed combined recurrent vascular lesions, and had significantly elevated hsCRP and IL-6, and greater number of LIs and MB at baseline as compared with those with recurrence in single vascular lesions. Conclusion: The present result suggest that multiple subcortical vascular lesions are already a strong risk for the recurrence, and chronic inflammation may have additional risk for the combined vascular lesions.

Apraxia for differentiating Alzheimer’s disease from subcortical vascular dementia and mild cognitive impairment

Although ideomotor limb apraxia is considered to be a typical sign of cortical pathologies such as Alzheimer’s disease (AD), it has been also reported in subcortical neurodegenerative diseases and vascular lesions. We aimed to investigate the difference between AD, subcortical vascular dementia (SVaD) and mild cognitive impairment (MCI) patients by means of ideomotor limb apraxia frequency and severity. Ninety-six AD, 72 SVaD, and 84 MCI patients were assessed with the mini-mental status examination (MMSe), clinical dementia rating (CDR) and the apraxia screening test of TULIA (AST). Apraxia was significantly more frequent in the AD patients (32.3%) than in both of the SVaD (16.7%) and MCI (4.8%) patients. The frequency of apraxia was also significantly higher in SVaD patients than in MCI patients. AD patients had significantly lower apraxia scores than both SVaD and MCI patients. In addition, a significant difference was found between SVaD and MCI patients in terms of apraxia scores. These results suggest that the widespread belief of the association between apraxia and cortical dementias is not exactly correct. The significant difference between both of the dementia groups and the MCI patients suggests that the absence of apraxia can be an indicator for MCI diagnosis.

Uncommon Lesions in the Internal Auditory Canal (IAC): Review of the Literature and Case Report

Despite the relatively frequent occurrence of multiple primary tumors, namely, 10% of intracranial tumors, metastasis is a rare occurrence within the internal auditory canal (IAC) and cerebellopontine angle (CPA). Intracanalicular metastases of adenocarcinoma are documented, but a primary adenocarcinoma remains unreported. We provide a review of uncommon lesions in the IAC and describe to our knowledge the first instance of a primary adenocarcinoma. A 60-year-old man presented with nausea and vomiting. Cranial computed tomography scan revealed bilateral nonspecific periventricular and subcortical vascular lesions. He presented 8 months later with left-sided tinnitus, progressive hearing loss, and attacks of vertigo. Magnetic resonance imaging (MRI) showed an extra-axial mass most likely representing a left-sided vestibular schwannoma with characteristic contrast enhancement in the IAC. The follow-up MRI showed an unchanged pattern of contrast enhancement. Due to progressive headaches and dizziness, the patient underwent a left transtemporal craniotomy with subtotal tumor resection. Histological examination revealed blennogenic cylindrical adenocarcinoma. The investigations for the primary tumor site were all negative. The patient's condition deteriorated gradually. MRI showed an increase of the residual tumor and meningeosis carcinomatosa, and cerebrospinal fluid (CSF) examination was positive for tumor cells. The patient was treated with intrathecal chemotherapy. He died of multiple organ failure. The discussion focuses on the incidence of extra-axial CPA and IAC lesions with their clinical presentations and their radiological findings. We address the issue of a possible regulation of CPA lesion laterality by asymmetrically expressed genes. In view of the sparse literature on treatment of single intracanalicular metastases, the review is broadened to the current treatment recommendations of single brain metastases. The differentiation between benign and malign lesions in the CPA and IAC is important, as it requires diverse treatment protocols. For the physician this differentiation represents a clinical and radiological challenge. For the developmental research the left-right asymmetry might be a field of research.

Increasing Awareness of the Factors Producing Falls: The Mini Falls Assessment

Falls represent one of the most common harmful occurrences in nursing homes, and injurious falls account for approximately 60% of all liability cases filed against nursing homes.1,2 Persons in nursing homes fall three times more frequently than persons living in the community. There are approximately 1.7 (0.6e3.6) falls per nursing home bed per year.3 Falls are the major cause of hip fractures, head trauma, lacerations, other fractures, and soft tissue injuries. As we age, falls are inevitable; therefore, our goals are to decrease the number of falls and prevent injuries where possible. Among nursing home residents, rates of hip fracture can be as high as 6.2% in women and 4.9% in men.4 The cost of falls in the United States is estimated to be $40 billion by 2020.5 Although single intervention programs have minor effects on falls, the Cochrane review has found that multifactorial interventions successfully reduce falls.6,7 Despite this, certified nursing aides believe that falls are not preventable.8 Numerous physiological changes occur with aging that increase the propensity for falls. The development of frailty,9e20 weight loss,21e24 and sarcopenia,25e32 which are all common in the nursing home, leads to the increased propensity for falls. Physiological changes increasing the likelihood of falls include decreased muscle strength, altered length and height of steps, increased dual foot contact time, a broader walking base, and slowed walking speed. Both very slow ( 1.3 m/s) walking speeds are associated with increased falls.33 A decline in vestibular function (30% loss of hair cells and nerve fibers), decreased nerve conduction owing to axonal atrophy, and alterations in joint function result in a decline in propioception. This leads to increased body sway. Older persons tend to develop backward disequilibrium or retropulsion, which leads to their tendency to fall backwards or to the side. This appears to be associated with increased subcortical vascular lesions.34 The decline in executive function with aging leads to the “stops talking while walking” syndrome or problems with dual tasking. Changes in vision (decline in visual acuity, cataracts, and age-related macular degeneration)35,36 and wearing bifocals37 are also associated with falls. Most falls are caused by tripping, as the ability to see and negotiate obstacles in time, and the ability to

Neuropsychological profiles in mild cognitive impairment and correlation with subcortical vascular lesions in Mexican elderly: A retrospective study

wiring FZ-F4, a clear grading from HC over MCI to AD could be found for the VSEP latencies with significant results between HC and AD (N1: p1⁄40.006, P2: p1⁄40.001) and significant results in the linear trend test (P1: p1⁄40.006, N1: p1⁄40.005, P2: p1⁄40.001), but no significant differences between HC andMCI resp. MCI and AD. In C4-F4, significant differences between AD and HC (p1⁄40.009) as well as between MCI and HC (p1⁄40.001) could be shown for P1, but no difference between the two groups of patients. As expected no potentials occurred on the left side of the head. The amplitudes of the VSEP are dispersed with no systematic link to the diagnoses of cognitive decline. Conclusions: VSEP is able to discriminate between cognitively declined patients and healthy controls with regard to the latencies of the potentials. The difference between MCI and AD reached no statistical significance, so further studies are necessary on the (diagnostic) specificity of the findings. The amplitudes of the potential have no diagnostic power.

Association of White Matter Lesions and Lacunar Infarcts With Executive Functioning: The SMART-MR Study

The authors investigated the association of white matter lesions and lacunar infarcts with cognitive performance and whether brain atrophy mediates these associations. Within the Second Manifestations of Arterial Disease-Magnetic Resonance study (2001-2005, the Netherlands), cross-sectional analyses of 522 patients were performed (mean age, 57 years (standard deviation, 10); 76% male). Brain segmentation was used to quantify volumes of brain tissue, cerebrospinal fluid, and white matter lesions. Infarcts were rated visually. Brain volume, ventricular volume, and gray matter volume were divided by intracranial volume to obtain indicators of brain atrophy. Neuropsychological tests assessing executive functioning and memory were performed, and scores were transformed into z scores. The authors used linear regression analyses, adjusted for age, sex, education, intelligence, and vascular risk factors, to investigate the association of white matter lesions and number of lacunar infarcts with cognitive performance. A 1-standard-deviation higher volume of white matter lesions (beta = -0.12, 95% confidence interval: -0.20, -0.04) and the presence of >or=2 lacunar infarcts (beta = -0.48, 95% confidence interval: -0.87, -0.09) were associated with worse executive functioning. These associations remained after adjusting for brain atrophy. Both were not associated with worse memory. Results suggest that subcortical ischemic vascular lesions are associated with decreased executive functioning, but not with memory functioning, independent of brain atrophy.

Neurolinguistic and acoustic analysis of speech and language disorders secondary to diffuse subcortical vascular lesions: A case report

Background and aims: Subcortical white matter (WM) plays an important role in speech production and language processing. Most frequently, cerebral WM lesions are secondary to small vessel disease in patients with vascular risk factors.

Speech and language disorders secondary to diffuse subcortical vascular lesions: Neurolinguistic and acoustic analysis. A case report

Background and purpose Subcortical white matter (WM) plays an important role in speech production and language processing. Most frequently, cerebral WM lesions are secondary to small vessel disease in patients with vascular risk factors. We report the case of a 53-year-old man with history of hypertension and ischemic subcortical lesions, who presented with speech difficulties and mild cognitive impairment. Methods Language and cognitive assessment included Boston Diagnostic Aphasia Examination, Boston Naming Test, Rey Auditory-Verbal Learning Test, Rey-Osterrieth Complex Figure Test, Trail Making Test A and B, Wisconsin Card Sorting Test, Scale for Evaluation of Perceptive Characteristics of Voice and Speech, and Multidimensional Evaluation of Speech and Voice. Results Brain MRI showed ischemic WM lesions and lacunar infarcts in the brainstem and right cerebellum. Cognitive testing revealed mild cognitive impairment, predominantly affecting attention and executive functions. Speech and language analysis demonstrated dysarthria, dysphonia with hypophonia, and imprecise articulation, as well as short rushes of speech, palilalia and mild subcortical dysphasia. Conclusions Neurolinguistic and acoustic analysis in patients with ischemic WM lesions can provide additional information in the understanding of language and speech disturbances, and can assist in patient management.

Estudio de correlación clinicoanatómica de la logorrea

The degree of verbal production necessary to be considered logorrhoea has still not been defined, and no clear correlation has been established between the topography of the dysfunction and this symptom.To provide quantitative data about normal verbal production and to identify the location within the brain of the alterations observed in neuroimage of patients with logorrhoea.The oral verbal production of 60 control subjects between 20 and 80 years of age was quantified by analysing five speeches. Ten patients who exceeded the 75th percentile in at least two of the five speeches underwent structural and functional neuroimaging tests. RESULTS. The data on verbal production of normal subjects are reported. Age, sex and habits (smoking, coffee, alcoholic drinks) did not exert an influence, but the degree of schooling was seen to have an effect. All the patients were diagnosed with frontotemporal degeneration, although in one case there were also coexisting vascular risk factors and subcortical vascular lesions, which reduce the degree of certainty of the diagnosis. Cortical atrophy is located in the right anterior temporal lobes (100% anteromedial, 100% anteroinferior, 70% anterolateral), left anterior temporal (90% anteromedial, 90% anteroinferior, 60% anterolateral), right prefrontal (30% basal, 50% dorsolateral, 20% medial) and left prefrontal (20% basal, 30% dorsolateral, 20% medial).Oral verbal production is influenced by level of education and, in a sample of patients with probable frontotemporal degeneration and logorrhoea, all the patients showed alterations in the anteroinferior and anteromedial regions of the right temporal lobe.

CSF levels of β‐amyloid 1‐42, tau and phosphorylated tau protein in CADASIL

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) can be considered a useful model of pure subcortical vascular dementia (SVD) because it occurs in young adults, unlikely to have concomitant age- and Alzheimer's disease (AD)-related pathology. In patients with CADASIL we evaluated the cerebrospinal fluid (CSF) levels of beta-amyloid 1-42 (Abeta42), total tau protein (t-tau) and phosphorylated tau protein (p-tau), which are well-accepted biomarkers of AD. The CSF Abeta42, t-tau and p-tau levels were determined with Innotest beta-amyloid 1-42, Innotest hTAU-Ag and Innotest Phospho-tau 181p sandwich enzyme-linked immunoassay, in 10 CADASIL patients and 17 healthy age-matched subjects. A case-control statistical analysis was carried out. CSF Abeta42 levels were significantly lower in CADASIL patients than in controls, whereas CSF t-tau and p-tau levels did not differ between the two groups. The pattern found in CADASIL patients is similar to that reported in those with sporadic SVD, suggesting that decreased CSF Abeta42 might be related to the subcortical vascular lesions in the white matter.

Subcortical Vascular Lesions Predict Falls at 12 Months in Elderly Patients Discharged From a Rehabilitation Ward

Guerini F, Frisoni GB, Marrè A, Turco R, Bellelli G, Trabucchi M. Subcortical vascular lesions predict falls at 12 months in elderly patients discharged from a rehabilitation ward. Objective To test whether subcortical vascular lesions are associated with falls in elderly patients with gait disorder discharged from a rehabilitation ward. Design Secondary 12-month follow-up analysis of an observational survey focusing on the prevalence of subcortical vascular lesions in a population of elderly patients discharged from rehabilitation hospitals. Setting A rehabilitation and aged care unit. Participants Consecutively admitted elderly patients (N=214) with gait disorder. Interventions Not applicable. Main Outcome Measures On admission, all patients underwent comprehensive geriatric assessment including sociodemographics, cognitive and depressive symptoms, nutritional status, physical health, and functional status. Subcortical vascular lesions were assessed on computed tomography films with a validated rating scale. All patients received a standardized rehabilitative program. Twelve months after discharge, all patients were interviewed by telephone, mainly focusing on the occurrence of falls during the follow-up period. Potential predictors of falls were assessed in univariate and multivariate analyses. Results Univariate predictors of falls were age, sex, Mini-Mental State Examination, Barthel Index on admission, and subcortical vascular lesions. In multivariate analyses, subcortical vascular lesions were the only significant predictor of risk of falling; patients with moderate and severe subcortical vascular lesions scores had a greater risk of falling (odds ratio [OR]=3.0; 95% confidence interval [CI], 1.3–7.1; P=.012; OR=3.9; 95% CI, 1.6–9.2; P=.002, respectively) than those with no subcortical vascular lesions. Conclusions Subcortical vascular lesions are associated with falls at 12 months in elderly patients with gait disorder discharged from a rehabilitative ward. Future research is needed to confirm our results.

Differentiating early and late‐onset depression with multichannel near‐infrared spectroscopy

AbstractBackground: Individuals with late‐life depression can be divided into two categories, those with early and late‐onset depression (EOD and LOD, respectively). It has been reported that LOD has more accentuated subcortical vascular lesions and frontal lobe dysfunction (hypofrontality). The aim of the present study was to examine whether LOD exhibits more prominent hypofrontality than EOD during performance of the word fluency task (WFT) under multichannel near‐infrared spectroscopy (NIRS), a newly developed non‐invasive functional neuroimaging technique.Methods: Eleven patients with EOD, 12 patients with LOD, and 13 healthy controls participated in the study. Clinical symptoms of depression were equivalent in the EOD and LOD groups. Brain magnetic resonance imaging demonstrated more robust subcortical vascular changes in LOD than EOD. The NIRS images were obtained using an ETG‐4000, 52‐channel NIRS system (Hitachi Medical, Tokyo, Japan). Mean changes in oxy‐hemoglobin (oxy‐Hb) were evaluated while the participants performed the phonemic WFT.Results: Healthy controls exhibited clear increases in oxy‐Hb bilaterally throughout the medial to the lateral frontal cortices and the superior temporal areas during the WFT. In contrast, increases in oxy‐Hb were mildly attenuated in EOD and severely attenuated in LOD in most channels. Subsequent analyses revealed that increases in oxy‐Hb in LOD during the WFT was significantly poorer than in EOD in the left lateral portion of the cortex, including the dorsolateral prefrontal and the superior temporal areas. In addition, significant negative correlations were obtained between the age of onset and oxy‐Hb, as well as between subcortical vascular changes and oxy‐Hb in the lateral channels. These findings suggest that the higher the age of onset of depression, and the more prominent the vascular lesions, the greater the attenuation in lateral frontal and temporal activation, as indicated by NIRS.Conclusions: Multichannel NIRS is useful for demonstrating attenuated functional activation in the left lateral prefrontal and temporal areas in LOD and, thus, for differentiating between LOD and EOD. The NIRS findings observed may have useful clinical implications for treatment‐resistant LOD.