Omineca Herald, October, 04, 1979

The relation between progression of cerebral small vessel disease (SVD) and gait decline is uncertain, and diffusion tensor imaging (DTI) studies on gait decline are lacking. We therefore investigated the longitudinal associations between (micro) structural brain changes and gait decline in SVD using DTI. 275 participants were included from the Radboud University Nijmegen Diffusion tensor and Magnetic resonance imaging Cohort (RUN DMC), a prospective cohort of participants with cerebral small vessel disease aged 50–85years. Gait (using GAITRite) and magnetic resonance imaging measures were assessed during baseline (2006–2007) and follow-up (2011−2012). Linear regression analysis was used to investigate the association between changes in conventional magnetic resonance and diffusion tensor imaging measures and gait decline. Tract-based spatial statistics analysis was used to investigate region-specific associations between changes in white matter integrity and gait decline. 56.2% were male, mean age was 62.9years (SD8.2), mean follow-up duration was 5.4years (SD0.2) and mean gait speed decline was 0.2m/s (SD0.2). Stride length decline was associated with white matter atrophy (β=0.16, p=0.007), and increase in mean white matter radial diffusivity and mean diffusivity, and decrease in mean fractional anisotropy (respectively, β=−0.14, p=0.009; β=−0.12, p=0.018; β=0.10, p=0.049), independent of age, sex, height, follow-up duration and baseline stride length. Tract-based spatial statistics analysis showed significant associations between stride length decline and fractional anisotropy decrease and mean diffusivity increase (primarily explained by radial diffusivity increase) in multiple white matter tracts, with the strongest associations found in the corpus callosum and corona radiata, independent of traditional small vessel disease markers. White matter atrophy and loss of white matter integrity are associated with gait decline in older adults with small vessel disease after 5years of follow-up. These findings suggest that progression of SVD might play an important role in gait decline. Keywords: Cerebral small vessel disease (SVD), MRI, Diffusion tensor imaging (DTI), Tract-based spatial statistics (TBSS), Gai

Risk factors and causes of ischemic stroke in 1322 young adults

Background:Identification of risk factors and causes of stroke is key to optimize treatment and prevent recurrence. Up to one-third of young patients with stroke have a cryptogenic stroke according to current classification systems (Trial of ORG 10172 in Acute Stroke Treatment [TOAST] and atherosclerosis, small vessel disease, cardiac pathology, other causes, dissection [ASCOD]). The aim was to identify risk factors and leads for (new) causes of cryptogenic ischemic stroke in young adults, using the pediatric classification system from the IPSS study (International Pediatric Stroke Study).Methods:This is a multicenter prospective cohort study conducted in 17 hospitals in the Netherlands, consisting of 1322 patients aged 18 to 49 years with first-ever, imaging confirmed, ischemic stroke between 2013 and 2021. The main outcome was distribution of risk factors according to IPSS classification in patients with cryptogenic and noncryptogenic stroke according to the TOAST and ASCOD classification.Results:The median age was 44.2 years, and 697 (52.7%) were men. Of these 1322 patients, 333 (25.2%) had a cryptogenic stroke according to the TOAST classification. Additional classification using the ASCOD criteria reduced the number patients with cryptogenic stroke from 333 to 260 (19.7%). When risk factors according to the IPSS were taken into account, the number of patients with no potential cause or risk factor for stroke reduced to 10 (0.8%).Conclusions:Among young adults aged 18 to 49 years with a cryptogenic ischemic stroke according to the TOAST classification, risk factors for stroke are highly prevalent. Using a pediatric classification system provides new leads for the possible causes in cryptogenic stroke, and could potentially lead to more tailored treatment for young individuals with stroke.Neurological Motor Disorder

Trigger factors for stroke in young adults: a case-crossover study

Background and ObjectivesCauses of stroke in young adults differ from those in the elderly individuals, and in a larger percentage,no cause can be determined. To gain more insight into the etiology of (cryptogenic) stroke in theyoung population, we investigated whether trigger factors, such as short-lasting exposure to toxins orinfection, may play a role.MethodsPatients aged 18–49 years with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) in 17participating centers in the Netherlands completed a questionnaire about exposure to 9 potentialtrigger factors in hazard periods and on a regular yearly basis. A case-crossover design was used toassess relative risks (RRs) with 95% confidence intervals (95% CIs) by the Mantel-Haenszel case-crossover method, for any stroke (ischemic stroke and ICH combined) and for different etiologicsubgroups of ischemic stroke.ResultsOne thousand one hundred forty-six patients completed the questionnaire (1,043 patients withan ischemic stroke and 103 with an ICH, median age 44.0 years, 52.6% men). For any stroke, anincreased risk emerged within 1 hour of cola consumption (RR 2.0, 95% CI 1.5–2.8) and vigorousphysical exercise (RR 2.6, 95% CI 2.2–3.0), within 2 hours after sexual activity (RR 2.4, 95% CI1.6–3.5), within 4 hours after illicit drug use (RR 2.8, 95% CI 1.7–4.9), and within 24 hours afterfever or flu-like disease (RR 14.1, 95% CI 10.5–31.2; RR 13.9, 95% CI 8.9–21.9). Four triggerfactors increased the risk of other determined and cryptogenic ischemic stroke, 3 that of car-dioembolic stroke, 2 that of large vessel atherosclerosis and likely atherothrombotic strokecombined and stroke with multiple causes, and none that of stroke due to small vessel disease.DiscussionWe identified cola consumption, vigorous physical exercise, sexual activity, illicit drug use, fever, andflu-like disease as potential trigger factors for stroke in the young population and found differencesin the type and number of trigger factors associated with different etiologic subgroups of ischemicstroke. These findings might help in better understanding the pathophysiologic mechanisms of(cryptogenic) stroke in the young population.Paroxysmal Cerebral Disorder

Cognitive function in elderly individuals with cerebral small vessel disease. An MRI study.

Contains fulltext : 97730.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 30 november 2011Promotor : Bloem, B.R. Co-promotores : Leeuw, F.E. de, Dijk, E.J. van280 p

Risico op snelle algemene functionele achteruitgang bij oudere patiënten met ernstige cerebrale leeftijdsgerelateerde wittestofafwijkingen: de LADIS-studie.

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Hypertension and cerebral diffusion tensor imaging in small vessel disease

Contains fulltext : 84437.pdf (publisher's version ) (Open Access

Gait in elderly with cerebral small vessel disease.

Contains fulltext : 88568.pdf (publisher's version ) (Open Access)BACKGROUND AND PURPOSE: Gait disorders are common in the elderly and are related to loss of functional independence and death. White matter lesions (WMLs) may be related, but only a minority of individuals with WMLs has gait disorders. Probably other factors are involved, including location and the independent effect of frequently coinciding lacunar infarcts, the other aspect of cerebral small vessel disease. The aim of our study was to investigate the effect of both the severity and location of both WMLs and lacunar infarcts on gait. METHODS: Four hundred thirty-one independently living, nondemented elderly aged between 50 and 85 years with cerebral small vessel disease were included in this analysis and underwent MRI scanning. The number and location of lacunar infarcts were rated and WML volume was assessed by manual segmentation with automated delineating of different regions. Gait was assessed quantitatively with an electronic walkway as well as the semiquantitatively Tinetti and Timed-Up-and-Go test. RESULTS: WMLs and lacunar infarcts were both independently associated with most gait parameters with stride length as the most sensitive parameter related to WMLs. WMLs in the sublobar (basal ganglia/internal capsule) and limbic areas and lacunar infarcts in the frontal lobe and thalamus were related to a lower velocity. CONCLUSIONS: Cerebral small vessel disease is related to gait disturbances. Because small vessel disease may, in part, be preventable, it should be regarded as a potentially important target for postponing gait impairment.01 augustus 201

Subjective cognitive failures and hippocampal volume in elderly with white matter lesions.

Contains fulltext : 70915.pdf (publisher's version ) (Open Access)BACKGROUND: Subjective cognitive failures (SCF) and subjective memory failures (SMF) have been reported to be an early predictor of Alzheimer disease (AD) and have been attributed to white matter lesions (WML). Since AD is characterized by hippocampal degeneration, it is surprising that its relation with hippocampal atrophy has been investigated only sparsely. Previous studies on this are rare, limited in sample size, and did not adjust for WML. OBJECTIVE: To determine the relation between SCF and hippocampal volume in strata of objective cognitive performance among elderly without dementia with incidental WML. METHODS: The Radboud University Nijmegen Diffusion tensor and MRI Cohort study is a prospective cohort study among 503 subjects with WML aged between 50 and 85 years. All subjects underwent FLAIR and T1 MRI scanning. The amount of SCF and SMF was rated by the Cognitive Failure Questionnaire. Cognitive function was assessed by a cognitive screening battery. Volumetric measures of hippocampus and WML were manually performed. We assessed the relation between hippocampal volume and SCF and SMF adjusted for age, sex, education, depression, intracranial volume, and WML volume. RESULTS: Subjects with SCF and SMF had lower hippocampal volumes than those without (p = 0.01 and p = 0.02). This was most noteworthy in subjects with good objective cognitive performance (p(trend) = 0.007 and p(trend) = 0.03), and not in those with poor objective cognitive performance. CONCLUSION: Subjective cognitive failures (SCF) are associated with lower hippocampal volume, even in subjects without objective cognitive impairment and independent of white matter lesions. SCF has a radiologic detectable pathologic-anatomic substrate

Physical activity is related to the structural integrity of cerebral white matter

Contains fulltext : 128550.pdf (publisher's version ) (Open Access)OBJECTIVE: To investigate the relation between physical exercise and the microstructural integrity of cerebral white matter. METHODS: Four hundred forty individuals with cerebral small-vessel disease, aged between 50 and 85 years, without dementia, were included and underwent MRI scanning. Physical exercise was assessed with a structured questionnaire. The cross-sectional relation between physical exercise and the microstructural integrity of the white matter was assessed by applying Tract-Based Spatial Statistics to diffusion tensor imaging parameters. RESULTS: Being more physically active was negatively related to the mean, axial, and radial diffusivity in numerous regions of the white matter, indicative of higher white matter integrity. CONCLUSIONS: These data indicate an association between physical activity and the integrity of the cerebral white matter's microstructure. Prospective studies are required to investigate a possible causal association between physical activity and cognitive decline

Cognitive Function in Small Vessel Disease: The Additional Value of Diffusion Tensor Imaging to Conventional Magnetic Resonance Imaging: The RUN DMC Study

Item does not contain fulltextThe structural integrity of the cerebral white matter, including that of the white matter lesions (WML) and of the surrounding normal appearing white matter (NAWM), can be assessed with diffusion tensor imaging (DTI), which is suggested to be of added value in the explanation of cognitive dysfunction in cerebral small vessel disease (SVD). We investigated the value of DTI of NAWM and WML in addition to conventional magnetic resonance imaging (MRI) parameters in the variance of cognitive performance in subjects with SVD. 499 individuals with SVD, 50-85 years, without dementia, underwent MRI scanning, including a DTI sequence. Grey matter, white matter (WM), and WML volume, number of microbleeds, lacunar and territorial infracts, and mean diffusivity (MD) and fractional anisotropy (FA) in NAWM, WML, and total WM were related to cognitive performance in multivariate regression analyses, after adjustment for age, gender, and education. All MRI parameters together accounted for 1-6% of the variance in cognitive function on top of 22-36% already explained by age, gender, and level of education. Both mean MD and FA of the NAWM, WML, and total WM did not substantially contribute to the explained variance of cognitive function, to that already explained by conventional MRI parameters. When considered separately, the MD of the (NA)WM had the strongest association with cognitive performance. In conclusion, DTI of NAWM and WML has limited additional value to conventional MRI parameters in the etiological explanation of the variance in cognitive function among individuals with SVD