Sulcal Atrophy Research Articles

Urinary selenium, cranial MRI, and cognitive function in American Indians: The Strong Heart Study.

Selenium (Se), a trace element found in soil and groundwater, is necessary for many biological functions, including cerebrovascular health, through selenoprotein formation. However, high concentrations may be harmful. American Indians face elevated cerebrovascular disease rates, which may be associated with other trace elements, such as Se. This cohort study evaluates associations of Se levels with brain health in older American Indians. The Strong Heart Study is a longitudinal cohort of American Indians, with comprehensive medical assessments, including trace element exposure assessment. Urinary Se measurements, brain MRIs, and neuropsychological testing were available for 728 participants aged 65-95at the time of brain MRI. We evaluated associations of urinary Se (divided by urinary creatinine to account for urine dilution) with MRI and neuropsychological tests and adjusted for potential confounders using linear regression models. Increased urinary Se was significantly associated with abnormal sulcal atrophy, ventricular widening, and increased white matter hyperintensity volume but not independent of sociodemographic factors and common vascular co-morbidities. Increased urinary Se was also significantly and independently associated with decreased performance in verbal fluency and processing speed, independent of sociodemographics, vascular co-morbidities, depression, and traumatic brain injury. These findings suggest urinary Se levels, particularly those above 50-60μg Se/g creatinine, are associated with adverse structural brain findings on imaging and diminished cognitive health in older American Indians. This epidemiologic evidence may be useful for public health professionals in evaluating environmental risk, especially within the context of vulnerable populations and high Se intake.

Differentiating MCI from depression through verbal memory scores.

The present study aims to assess the differences between major depressive disorder (MDD) and mild cognitive impairment (MCI) in terms of verbal learning profile together with structural changes in the brain on magnetic resonance imaging (MRI) and to reveal predictive factors for MCI. Fifty-six patients with MDD and 31 MCI subjects were assessed using the Turkish Verbal Memory Processes Test (VMPT). Brain MRI was used to evaluate sulcal atrophy (SA), ventricular atrophy, periventricular white matter hyperintensity (WMH), subcortical WMH, basal ganglia infarct, medial temporal lobe atrophy, and infratentorial infarct scores based on the Modified Visual MRI Rating Scale (MVMRS). The symptoms of depression were evaluated with the Beck Depression Inventory in both groups. Demographic factors, VMPT scores, and MVMRS scores between MDD and MCI groups were compared. Also, potential predictors of MCI were analyzed by binary logistic regression analyses. The total scores of VMPT and the scores of VMPT subgroups, including immediate memory, highest learning, total learning, and delayed recall, were significantly higher in the MDD groups compared to MCI patients (Mann-Whitney U, Student's t-test, p < 0.05), indicating that higher scores were associated with better memory. The total MVMRS score and a subgroup of MVMRS, the SA score, were significantly higher in MCI patients compared to the MDD group, suggesting more atrophic changes and a higher burden of infarction in MCI patients. In our statistical analyses, impaired immediate memory (p < 0.001; OR = 6.002; 95% CI: 1.996-18.042), increased SA (p = 0.008; OR = 1.522; 95% CI: 1.118-2.073), and education (p = 0.028; OR = 0.84; 95% CI: 0.719-0.981) were significant predictive values obtained through backward Wald elimination in the binary logistic regression model for detecting MCI. Our findings suggest that VMPT may potentially represent a novel neuropsychiatric test that might be combined with MRI-based morphometric evaluation methods, such as MVMRS.

Electrocardiogram properties and risk of covert brain infarction and other magnetic resonance imaging abnormalities in a stroke-free population.

This study aimed to investigate the association between electrocardiogram (ECG) abnormalities and silent vascular brain injury as defined by cerebral magnetic resonance imaging (MRI) in a stroke-free community-based population. A total of 5888 participants were studied from the Cardiovascular Health Study (CHS), a prospective cohort of community-living older adults. Standard 12-lead ECGs measured prior to MRI scan were used. MRI scans were conducted at years 4-6 and 10-11. The primary outcome was presence of incident covert brain infarcts (CBIs) on the 2nd MRI examination, excluding previous CBIs and stroke occurrence. Secondary outcomes included white matter, ventricular, and sulcal atrophy on the 1st MRI. Logistic and multiple linear regression models were used to assess the relationship between ECG findings and silent vascular brain injury. Left axis deviation before MRI scan was related to presence of incident CBIs (odds ratio [OR]: 1.45; 95% CI: 1.01-2.08, p=.047). A long QT interval was associated with severe white matter hyperintensity (OR: 1.36; 95% CI: 1.04-1.77, p=.024). Minor Q and QS waves with ST-T abnormalities were positively related to sulcal atrophy (β: 0.43, 95% CI: 0.06-0.81, p=.023). Our study found that ECG abnormalities were related to presence of CBIs, white matter hyperintensity, and sulcal atrophy on MRI in a stroke-free relderly population. Specifically, those with left axis deviation had an increased risk of presence of CBIs.

Interrater reliability of modified visual mrı rating scale assessing atrophy and white matter changes.

<p>Cortical atrophy and white matter changes are common findings on magnetic resonance imaging among elderly. Several visual scales have been proposed to evaluate these changes using neuroimaging. We have recently proposed a scale (Modified Visual Magnetic Resonance Rating Scale) recently which allows us to evaluate atrophy, white matter hyperintensities, basal ganglia and infratentorial infarcts together. Our aim in this study was to evaluate the interrater reliability of magnetic resonance visual assessment using this scale between two neurologists and a radiologist.&nbsp;</p>. <p>Randomly selected 30 patients in different ages who underwent brain magnetic resonance imaging between January 2014 and March 2015 were included. Axial T1, coronal T2, and axial FLAIR sequences were visually scored by two neurologists and one radiologist separately. Sulcal, ventricular and medial temporal lobe atrophy, periventricular and subcortical white matter hyperintensities, basal ganglia and infratentorial infarcts were graded according to our scale. The interrater reliability and internal consistency analysis were evaluated by using intraclass correlation coefficient and Cronbach&rsquo;s alpha tests.&nbsp;</p>. <p>The interrater agreements vary between good to excellent. The interrater correlations are moderate to excellent. Interrater correlations were excellent between two neurologists, especially on ventricular atrophy, medial temporal atrophy, basal ganglia infarcts, infratentorial infarcts. When assessing ventricular atrophy, interrater correlations between individual raters were higher than sulcal atrophy. We found good correlations between neurologists and radiologist, and excellent correlations between the two neurologists for medial temporal atrophy. We found excellent interrater correlations between neurologists and radiologist for white matter hyperintensities.</p>. <p>Our scale is a reliable tool assessing both atrophy and white matter hyperintensities with a good interrater reliability. Ventricular atrophy seems to be a more reliable marker than sulcal atrophy when assessing the atrophy on neuroimaging of a patient with memory decline. We think that the total score of the scale will also guide us in clinical practice.</p>.

Educational and Clinical Associations With Longitudinal Cognitive Function and Brain Imaging in American Indians: The Strong Heart Study.

Little is known about incidence of vascular and Alzheimer dementias in American Indians. We conducted a large, heterogeneous, population-based, longitudinal cohort study of brain aging in community-dwelling American Indians aged 64-95 years from 11 tribes across 3 states, with neurologic examinations, 1.5T MRI, and extensive cognitive testing. Visit 1 in 2010-2013 (n = 817) and visit 2 in 2017-2019 (n = 403) included all willing, surviving participants. Standardized cognitive tests at both visits included Modified Mini-Mental Status Examination (MMSE), Wechsler Adult Intelligence Scale digit symbol coding (WAIS), Controlled Oral Word Association (COWA), and California Verbal Learning Test short form (CVLT). Test materials added at follow-up included Wide Range Achievement (reading) Test (WRAT) and National Alzheimer Coordinating Center Uniform Data Set cognitive battery (v3 form C2), including Montreal Cognitive Assessment (MoCA). MRI neuroradiologists coded infarcts, hemorrhages, white matter hyperintensities, sulcal atrophy, and ventricle enlargement. The mean time between examinations was 6.7 years (SD 1.1, range 3.8-9.1 years). Years of formal education had modest correlation with WRAT reading score (r = 0.45). Prevalence and incidence (respectively) of infarcts were 32% and 12.8/1,000 person-years (PYs) hemorrhages 6% and 4.4/1000 PY worsening sulci 74% and 19.0/1000 PY worsening ventricle 79% and 30.1/1000 PY worsening leukoaraiosis 44% and 26.1/1000 PY. Linear losses per year in cognitive scores were 0.6% MMSE, 1.2% WAIS, 0.6% COWA, and 2.2% CVLT. The mean MoCA scores were 18.9 (SD 4.3). These are the first data on longitudinal cognitive and imaging changes in American Indians and first reports of Alzheimer disease-related features. The mean scores in MoCA were similar or lower than standard cutoffs used to diagnose dementia in other racial/ethnic groups, suggesting that standardized cognitive tests may not perform well in this population. Test validation, adaptation, and score adjustment are warranted. Years of education were a poor proxy for premorbid function, suggesting novel methods for cognitive score contextualization is also needed in this population. Evaluation of selective survival suggests attrition from death, and frailty should be accounted for in causal analyses. Overall, these data represent a unique opportunity to examine neurology topics of critical importance to an understudied population.

Modified Visual Magnetic Resonance Scale and Neuropsychometric Corelations in Alzheimer's disease

Amaç: Alzheimer hastalığı (AH) araştırmaları için daha ileri nörogörüntüleme teknikleri geliştirilmiş olsa da, yapısal manyetik rezonans görüntüleme (MRG) AH’nin klinik tanısında önemini korumaktadır. Birçok parametreyi değerlendiren kapsamlı görsel MRG derecelendirme ölçeklerinin, hastalığın kognitif ve davranışsal görünümleriyle ilişkisi yeterince araştırılmamıştır. Bu çalışmada, Modifiye Görsel Manyetik Rezonans Derecelendirme Skalası’nın (MGMRDS) 7 alt bölümünün, AH tanısı almış hastaların demografik, kognitif ve davranışsal verileri ile korelasyonunu değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: Retrospektif çalışmamıza beyin MRG ve nöropsikometrik test (NPT) verileri olan, Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı (DSM-IV-TR) ölçütleri ile Ulusal Nörolojik ve İletişimsel Bozukluklar ve İnme Enstitüsü &amp;amp; Alzheimer Hastalığı ve İlişkili Bozukluklar Derneği (NINCDS–ADRDA) kriterleri temelinde AH tanısı almış, 50 yaş ve üzeri toplam 42 hasta dahil edildi. Beyin MRG verileri, hasta yaş, cinsiyet ve tanı verilerine kör bir nöroradyolog tarafından MGMRDS kullanılarak değerlendirildi. MGMRDS verilerinin kognitif ve davranışsal test sonuçlarıyla korelasyonu incelendi. Bulgular: Hastaların %61,9’u kadın, yaş ortalaması 75,19±9,26 (53–92) yıl idi. Ortalama eğitim süresi 5,02±4,84 (0–15) yıl, ortalama hastalık süresi 4,52±2,94 yıldı. Ortalama Mini Mental Durum Testi skoru 18,51±5,43 (4–30) iken, ortalama Klinik Demans Derecelendirmesi (KDD) skoru 1,07±0,42 (0,5–2,0) idi. Sulkal atrofi puanları uzun süreli hatırlama ve yüz tanıma ile negatif korele idi; ventriküler atrofi skorları ise öğrenme puanları, meyve–insan ve yüz tanıma değişkenleri ile ters korelasyon gösterdi. Anlık hatırlama, öğrenme puanı, kendiliğinden hatırlama, meyve–insan ve KDD değişkenleri ile mediyal temporal atrofi değişkeni arasında anlamlı ilişki gözlendi. Tartışma ve Sonuç: Beyin MRG’ye dayalı görsel derecelendirme skalaları kullanmak, demans değerlendirmelerinde tanıyı doğrulayıcı, ucuz ve pratik bir yaklaşımdır. MGMRDS, kognitif (yürütücü işlevler, bellek, dikkat, dil) verilerle de anlamlı korelasyon göstermektedir. Bu ölçeği daha geniş hasta gruplarında değişik kognitif bozukluklarda değerlendirecek çalışmalar klinik açıdan faydalı olacaktır.

Association of brain white matter lesions and atrophy with cognitive function in chronic kidney disease.

Cognitive impairment is common in patients with chronic kidney disease (CKD), possibly leading to poor outcomes. However, the correlation between brain structural abnormalities and cognitive impairment remains unclear. The aim of this study was to investigate the impairment of specific cognitive domains and their association with brain structural abnormalities. Patients with CKD of at least stage 3 who were not on hemodialysis were enrolled. All participants underwent comprehensive neuropsychological testing in five cognitive domains. Ventricular atrophy, sulcal atrophy, medial temporal atrophy, and white matter changes were assessed using brain magnetic resonance imaging according to standard protocols. Eighty-seven patients and 50 controls were enrolled. Patients with CKD exhibited decreased cognitive function relative to controls. Compared with patients with stage 3 CKD, those with advanced stage (stages 4 or 5) had poorer cognitive performance, more pronounced white matter hyperintensity (WMH) and more severe ventricular atrophy. Among CKD patients, executive function (β = -.23, P = .043) and attention (β = -.29, P = .004) were associated with WMH in controlled analyses. However, no cognitive impairment was associated with ventricular atrophy. Patients with CKD exhibited cognitive impairment and brain structural abnormalities including WMH and general brain atrophy. Impairment of attention and executive dysfunction were associated with WMH.

Modified Visual Magnetic Resonance Rating Scale for Evaluation of Patients with Forgetfulness.

As cognitive impairment increases with age, sulcal atrophy (SA) and the enlargement of the ventricles also increase. Considering the measurements on the previously proposed visual scales, a new scale is proposed in this study that allows us to evaluate the atrophy, white matter hyperintensities (WMHs), basal ganglia infarct (BGI), and infratentorial infarct (ITI) together. Our aim of this study is to propose a practical and standardized MRI for the clinicians to be used in daily practice. A total of 97 patients older than 60 years and diagnosed with depression or Alzheimer's disease (AD) are included. Cranial MRI, Mini Mental State Examination (MMSE), detailed neuropsychometric tests, and depression scales are applied to all patients. The SA, ventricular atrophy (VA), medial temporal lobe atrophy (MTA), periventricular WMH (PWMH), subcortical WMH (SCWMH), BGI, and ITI are scored according to the scale. The total score is also recorded. The average age of the patients was 74.53, and the mean MMSE score was 22.7 in the degenerative group and 27.8 in the non-degenerative group. Among the patients, 50 were diagnosed with AD. All parameters significantly increased with age. In the degenerative group, SA, VA, MTA, PWMH, SCWMH, and total scores were found to be significantly higher. Sensitivities of VA, PWMH, SCWMH, and total scores, as well as both sensitivity and specificities of MTA score, were observed to be high. When they were combined, sensitivities and specificities were found to be high. The scale is observed to be predictive in discriminating degenerative and non-degenerative processes. This discrimination is important, particularly in depressive patients complaining of forgetfulness.

Abstract 45: Effect Of Atrial Fibrillation On Brain Atrophy And Cognitive Deficits In Persons Aged ≥65 Years: Analysis Of Cardiovascular Health Study

Background: We tested the hypothesis that surrogate markers of brain degeneration such as atrophy are more prevalent in persons with atrial fibrillation who are at risk for cognitive deficits. Methods: We analyzed the data from the 2,962 women and 2,239 men and added minority cohort of 256 men and 431 women (all aged ≥65 years) enrolled in the Cardiovascular Health Study. Examination components have included medical history questionnaires, measurement of ankle-brachial index, abdominal and carotid ultrasound studies, ambulatory electrocardiograms, and cerebral magnetic resonance imaging (MRI) over the past decade. Atrophy was graded using a nine point scale (1 through 9) based on severity of atrophy. Logistic regression analysis was performed to determine the relationship between atrial fibrillation and prominent atrophy after adjusting for potential confounders. Results: Atrial fibrillation was present in 125 (3.4%) of the 2775 participants who received an MRI at baseline evaluation. The mean mini mental status score (±SD) was similar among participants with atrial fibrillation compared to those without atrial fibrillation (27.8 ±2.3 versus 27.6 ±2.7, p=0.4). The proportion of participants with prominent sulcal atrophy (score of 4 or greater) was non significantly higher among patients with atrial fibrillation (61 of 125 and 1097 of 2650, p=0.1). The proportion of participants with prominent ventricular atrophy (score of 4 or greater) was non significantly higher among patients with atrial fibrillation (69 of 126 and 1287 of 2651, p=0.2). The proportion of participants with previous cortical infarction (46 of 125 and 765 of 2650, p=0.06) and marked perivascular space expansion (5 of 125 and 27 of 2650, p=0.006) on MRI was significantly higher among patients with atrial fibrillation and sulcal atrophy. After adjusting for age, gender, and previous infarction, participants with atrial fibrillation did not have a higher risk of prominent atrophy (odds ratio 0.7, 95% confidence interval 0.5 -0.9, p=0.005). Conclusions: We observed that brain atrophy was more prevalent among persons with atrial fibrillation but due to the age differences and the higher occurrence of previous infarctions.

Never too old

In March, 2010, a 75-year-old woman was referred to us because of a 6-month history of progressive dementia. Her illness started with gait apraxia and progressed to cognitive decline with variable degrees of sphincter incontinence. She was an otherwise healthy woman with no history of previous medical conditions, and a widow of 15 years since her husband had died from a myocardial infarction. She had had three uneventful pregnancies, had never undergone surgery or blood transfusions, and did not come from a region with high HIV prevalence. She had loss of initiative and spontaneous speech, apathy, inattention, and short-term memory decline, and was unable to perform daily life activities without help. Neurological examination revealed an apraxic gait with small steps and a shift to the right, as well as a festinating gait. Her score on the mini-mental examination (MMSE) scale was 18. Neuropsychological examination showed impaired short-term memory, attention, and visuospatial abilities, and decreased mental processing speed. An electroencephalogram showed general slowing of background activity. Axial FLAIR MRI showed ventricular enlargement out of proportion to sulcal atrophy, and rounding of the frontal horns associated with periventricular hyperintensities, which suggested transependymal fl ow of cerebrospinal fl uid (CSF) (fi gure). To exclude secondary dementia due to normalpressure hydrocephalus, we did a tap test, which revealed normal opening pressure (17 mm Hg), with no Lancet 2011; 378: 1676

Age-related shift in brain region activity during successful memory performance

Coregistered positron emission tomography (PET)/magnetic resonance imaging (MRI) was used to characterize brain function in 70 volunteers, aged 20–87 years, during a verbal memory task. Frontal activity showed an age-related decline that remained significant after statistical control for sulcal atrophy. Analyses of young and old subgroups matched for memory scores revealed that young good performers activated frontal regions, whereas old good performers relied on occipital regions. Although activating different cortical regions, good performers of all ages used the same cognitive strategy—semantic clustering. Age-related functional change may reflect dynamic re-allocation in a network of brain areas, not merely anatomically fixed neuronal loss or diminished capacity to perform.

Cortical magnetic resonance imaging changes in elderly inpatients with major depression

The purpose of the study was to determine if magnetic resonance imaging (MRI) scans of elderly depressed patients differ from MRI scans of age-matched control subjects and age-matched patients with Alzheimer's disease. The authors studied 21 patients 60 years or older with major depression, 16 patients with Alzheimer's disease, and 14 age-matched control subjects. Compared to control subjects, depressed patients had greater cerebral sulcal and temporal sulcal atrophy; larger sylvian fissures, lateral ventricles, third ventricles, and temporal horns; and greater severity of subcortical white matter lesions. Depressed patients also had more basal ganglia lesions but similar levels of periventricular hyperintensity. There were no differences between depressed patients with and without delusions on any MRI measure. Depressed patients who received ECT had more temporal horn atrophy and greater subcortical abnormality summary scores than normal subjects. Cortical sulcal atrophy correlated with age at onset of depression. The findings suggest that elderly hospitalized depressed patients have greater cortical as well as subcortical atrophy and more basal ganglia lesions than age-matched normal control subjects. The correlation of these abnormalities with outcome remains unknown.

Sleep spindles in normal elderly: comparison with young adult patterns and relation to nocturnal awakening, cognitive function and brain atrophy

Visual measurements of sleep spindles were carried out in 48 elderly and 20 young normal adults. Computed tomography brain scans and psychometric testing were also performed. Earlier findings of reduced spindle abundance, amplitude and duration in the elderly were confirmed. In addition, we demonstrated a linear increase in spindle density and duration across NREMPs in young adults that was absent in the elderly, indicating that age effects the temporal pattern as well as the quantity of spindles. Contrary to what seemed a highly plausible hypothesis, the amount of waking in the elderly was not inversely correlated with spindle abundance, confirming earlier observations (Feinberg et al. 1967) but in a much larger group. This finding suggests that spindle abundance does not reflect the integrity of the systems that maintain the brain in NREM sleep. We also were unable to show any clear evidence that relative preservation of spindles in the elderly is associated with relative preservation of cognitive skills: psychometric performance and spindle measures were, in most instances, not significantly correlated. However, the test of this hypothesis was limited by the high level of function and the narrow range of impairment of these Ss. One intriguing positive finding was the significant inverse relation between ratings of sulcal atrophy and spindle amplitude. This observation suggests an etiology for the reduced amplitude of the sleep EEG in old age. This change is one of the most striking effects of age on brain electrophysiology.

Cranial CT scans in eating disorder patients and controls

Computed tomography (CT) scans of 21 patients with eating disorders were compared with those of 14 nonpsychotic controls. Of 14 patients with anorexia nervosa, 8 had cerebral ventricular enlargement, and 4 of these also had cortical sulcal atrophy, both by global assessment as compared with none of the controls. Ventricular brain ratio (VBR) and third ventricular measurements were also significantly increased in anorectics in comparison with 5 bulimic patients or controls. CT abnormalities were significantly correlated with rate of and degree of weight loss from premorbid weight but not with loss from estimated minimal healthy weight. Of any clinical features of anorexia, only hypothermia correlated with CT scan abnormality. Review of other reports of CT abnormalities in anorectics and implications for further investigation are discussed.