scholarly journals Neuropsychiatric Correlates of Small Vessel Disease Progression in Incident Cognitive Decline: Independent and Interactive Effects

2020 ◽  
Vol 73 (3) ◽  
pp. 1053-1062
Author(s):  
Cheuk Ni Kan ◽  
Bibek Gyanwali ◽  
Saima Hilal ◽  
Kok Pin Ng ◽  
Narayanaswamy Venketasubramanian ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Disease Progression ◽  
Small Vessel Disease ◽  
Interactive Effects ◽  
Small Vessel ◽  
Vessel Disease

scholarly journals Cilostazol for Secondary Prevention of Stroke and Cognitive Decline

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2374-2385 ◽  
Author(s):  
Caroline McHutchison ◽  
Gordon W. Blair ◽  
Jason P. Appleton ◽  
Francesca M. Chappell ◽  
Fergus Doubal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Decline ◽  
Hemorrhagic Stroke ◽  
Small Vessel Disease ◽  
Asia Pacific ◽  
Small Vessel ◽  
Controlled Trials ◽  
Lacunar Stroke ◽  
Vessel Disease ◽  
Randomized Controlled

Background and Purpose: Cilostazol, a phosphodiesterase 3’ inhibitor, is used in Asia-Pacific countries for stroke prevention, but rarely used elsewhere. In addition to weak antiplatelet effects, it stabilizes endothelium, aids myelin repair and astrocyte-neuron energy transfer in laboratory models, effects that may be beneficial in preventing small vessel disease progression. Methods: A systematic review and meta-analysis of unconfounded randomized controlled trials of cilostazol to prevent stroke, cognitive decline, or radiological small vessel disease lesion progression. Two reviewers searched for papers (January 1, 2019 to July 16, 2019) and extracted data. We calculated Peto odds ratios (ORs) and 95% CIs for recurrent ischemic, hemorrhagic stroke, death, adverse symptoms, with sensitivity analyses. The review is registered (CRD42018084742). Results: We included 20 randomized controlled trials (n=10 505), 18 in ischemic stroke (total n=10 449) and 2 in cognitive impairment (n=56); most were performed in Asia-Pacific countries. Cilostazol decreased recurrent ischemic stroke (17 trials, n=10 225, OR=0.68 [95% CI, 0.57–0.81]; P <0.0001), hemorrhagic stroke (16 trials, n=9736, OR=0.43 [95% CI, 0.29–0.64]; P =0.0001), deaths (OR=0.64 [95% CI, 0.49–0.83], P <0.0009), systemic bleeding (n=8387, OR=0.73 [95% CI, 0.54–0.99]; P =0.04), but increased headache and palpitations, compared with placebo, aspirin, or clopidogrel. Cilostazol reduced recurrent ischemic stroke more when given long (>6 months) versus short term without increasing hemorrhage, and in trials with larger proportions (>40%) of lacunar stroke. Data were insufficient to assess effects on cognition, imaging, functional outcomes, or tolerance. Conclusions: Cilostazol appears effective for long-term secondary stroke prevention without increasing hemorrhage risk. However, most trials related to Asia-Pacific patients and more trials in Western countries should assess its effects on cognitive decline, functional outcome, and tolerance, particularly in lacunar stroke and other presentations of small vessel disease.

scholarly journals Cognitive consequences of regression of cerebral small vessel disease

2018 ◽  
Vol 4 (1) ◽  
pp. 85-89 ◽  
Author(s):  
Esther MC van Leijsen ◽  
Mayra I Bergkamp ◽  
Ingeborg WM van Uden ◽  
Sjacky Cooijmans ◽  
Mohsen Ghafoorian ◽  
...  
Keyword(s):  
Executive Function ◽  
White Matter ◽  
Cognitive Decline ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease ◽  
Disease Markers ◽  
Total Brain

Introduction Recent studies have shown that neuroimaging markers of cerebral small vessel disease can also regress over time. We investigated the cognitive consequences of regression of small vessel disease markers. Patients and methods Two hundred and seventy-six participants of the RUNDMC study underwent neuroimaging and cognitive assessments at three time-points over 8.7 years. We semi-automatically assessed white matter hyperintensities volumes and manually rated lacunes and microbleeds. We analysed differences in cognitive decline and accompanying brain atrophy between participants with regression, progression and stable small vessel disease by analysis of variance. Results Fifty-six participants (20.3%) showed regression of small vessel disease markers: 31 (11.2%) white matter hyperintensities regression, 10 (3.6%) vanishing lacunes and 27 (9.8%) vanishing microbleeds. Participants with regression showed a decline in overall cognition, memory, psychomotor speed and executive function similar to stable small vessel disease. Participants with small vessel disease progression showed more cognitive decline compared with stable small vessel disease (p < 0.001 for cognitive index and memory; p < 0.01 for executive function), although significance disappeared after adjusting for age and sex. Loss of total brain, gray matter and white matter volume did not differ between participants with small vessel disease regression and stable small vessel disease, while participants with small vessel disease progression showed more volume loss of total brain and gray matter compared to those with stable small vessel disease (p < 0.05), although significance disappeared after adjustments. Discussion Regression of small vessel disease markers was associated with similar cognitive decline compared to stable small vessel disease and did not accompany brain atrophy, suggesting that small vessel disease regression follows a relatively benign clinical course. Future studies are required to validate these findings and to assess the role of vascular risk factor control on small vessel disease regression and possible recovery of clinical symptoms. Conclusion Our findings of comparable cognitive decline between participants with regression and stable small vessel disease might suggest that small vessel disease regression has a relative benign cognitive outcome.

scholarly journals Cerebral small vessel disease: Capillary pathways to stroke and cognitive decline

2015 ◽  
Vol 36 (2) ◽  
pp. 302-325 ◽  
Author(s):  
Leif Østergaard ◽  
Thorbjørn S Engedal ◽  
Fiona Moreton ◽  
Mikkel B Hansen ◽  
Joanna M Wardlaw ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Capillary Flow ◽  
Small Vessel Disease ◽  
Genetic Disorders ◽  
The Elderly ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vascular Pathology ◽  
Vessel Disease ◽  
Capillary Dysfunction

Cerebral small vessel disease (SVD) gives rise to one in five strokes worldwide and constitutes a major source of cognitive decline in the elderly. SVD is known to occur in relation to hypertension, diabetes, smoking, radiation therapy and in a range of inherited and genetic disorders, autoimmune disorders, connective tissue disorders, and infections. Until recently, changes in capillary patency and blood viscosity have received little attention in the aetiopathogenesis of SVD and the high risk of subsequent stroke and cognitive decline. Capillary flow patterns were, however, recently shown to limit the extraction efficacy of oxygen in tissue and capillary dysfunction therefore proposed as a source of stroke-like symptoms and neurodegeneration, even in the absence of physical flow-limiting vascular pathology. In this review, we examine whether capillary flow disturbances may be a shared feature of conditions that represent risk factors for SVD. We then discuss aspects of capillary dysfunction that could be prevented or alleviated and therefore might be of general benefit to patients at risk of SVD, stroke or cognitive decline.

Disease progression and regression in sporadic small vessel disease–insights from neuroimaging

2017 ◽  
Vol 131 (12) ◽  
pp. 1191-1206 ◽  
Author(s):  
Esther M.C. van Leijsen ◽  
Frank-Erik de Leeuw ◽  
Anil M. Tuladhar
Keyword(s):  
Disease Progression ◽  
Time Course ◽  
Temporal Dynamics ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Course Of Disease ◽  
Vessel Disease ◽  
Clinical Consequences ◽  
Dynamic Time

Cerebral small vessel disease (SVD) is considered the most important vascular contributor to the development of dementia. Comprehensive characterization of the time course of disease progression will result in better understanding of aetiology and clinical consequences of SVD. SVD progression has been studied extensively over the years, usually describing change in SVD markers over time using neuroimaging at two time points. As a consequence, SVD is usually seen as a rather linear, continuously progressive process. This assumption of continuous progression of SVD markers was recently challenged by several studies that showed regression of SVD markers. Here, we provide a review on disease progression in sporadic SVD, thereby taking into account both progression and regression of SVD markers with emphasis on white matter hyperintensities (WMH), lacunes and microbleeds. We will elaborate on temporal dynamics of SVD progression and discuss the view of SVD progression as a dynamic process, rather than the traditional view of SVD as a continuous progressive process, that might better fit evidence from longitudinal neuroimaging studies. We will discuss possible mechanisms and clinical implications of a dynamic time course of SVD, with both progression and regression of SVD markers.

Kidney function changes and their relation with the progression of cerebral small vessel disease and cognitive decline

2020 ◽  
Vol 409 ◽  
pp. 116635 ◽  
Author(s):  
Joan Jiménez-Balado ◽  
Iolanda Riba-Llena ◽  
Jesús Pizarro ◽  
Antoni Palasí ◽  
Anna Penalba ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Kidney Function ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease

scholarly journals Total Cerebral Small Vessel Disease MRI Score Is Associated with Cognitive Decline in Executive Function in Patients with Hypertension

2016 ◽  
Vol 8 ◽  
Author(s):  
Renske Uiterwijk ◽  
Robert J. van Oostenbrugge ◽  
Marjolein Huijts ◽  
Peter W. De Leeuw ◽  
Abraham A. Kroon ◽  
...  
Keyword(s):  
Executive Function ◽  
Cognitive Decline ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease ◽  
Mri Score

scholarly journals P4-286: CEREBRAL SMALL VESSEL DISEASE AND COGNITIVE DECLINE IN AN ASIAN MEMORY CLINIC POPULATION

2019 ◽  
Vol 15 ◽  
pp. P1395-P1396
Author(s):  
Bibek Gyanwali ◽  
Eddie Chong ◽  
Xin Xu ◽  
Narayanaswamy Venketasubramanian ◽  
Christopher Chen ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Memory Clinic ◽  
Vessel Disease ◽  
Clinic Population

scholarly journals Small vessel disease neuroimaging markers contribute robustly and independently to longitudinal cognitive decline in older adults

2020 ◽  
Vol 16 (S4) ◽  
Author(s):  
Corey W. Bown ◽  
Omair A. Khan ◽  
Dandan Liu ◽  
Francis E. Cambronero ◽  
Elizabeth E. Moore ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease
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