Xue-Yuan Liu

Late-onset depression in the absence of stroke: associated with silent brain infarctions, microbleeds and lesion locations.

Background: Late-onset depression (LOD) is a frequent mood disorder among elderly. Previous studies have proved that LOD is associated with cerebral silent lesions especially white matter lesions (WML) and yielded the “vascular depression” hypothesis to explain the pathogenesis of LOD. However, there were relatively few studies about the association between silent brain infarctions (SBIs), microbleeds (MBs) and the prevalence of LOD. In this study we sought to evaluate the presence, accumulation and locations of SBIs and MBs, and explore the possible association between them and LOD. Methods: 65 patients of LOD diagnosed according to DSM-IV and 270 subjects of control group were enrolled and scanned by MRI to analyze the presence, numbers and locations of SBIs and MBs. Clinical and radiological characteristics were compared between LOD patients and control group. Logistic regression models were constructed to identify the independent risk factors for LOD. Results: LOD patients had higher prevalence and numbers of both SBIs and MBs. SBIs and MBs in the left hemisphere, SBIs in basal ganglia and lobar MBs were all independent risk factors for LOD. Conclusion: The presence of both SBIs and MBs were associated with a higher rate LOD. Lesions in some specific locations might be critical for the presence of LOD.

Depression in silent lacunar infarction: a cross-sectional study of its association with location of silent lacunar infarction and vascular risk factors

Most previous studies reported a close link between fresh infarcts and post-stroke depression. However, studies on the relation of depression and silent lacunar infarction (SLI) are limited. This study aims to analyze the effects of SLI and the vascular risk factors on depression. A total of 243 patients with SLI were divided into depression and non-depression groups. The presence and location of SLI were evaluated with magnetic resonance imaging. Depression was assessed with the Patient Health Questionnaire-9 and vascular risks factors were collected. We used t tests and χ2 test to compare the baseline characteristics of the two groups and the multivariate logistic regression model to identify the risk factors for depression. Univariate analysis results showed that the proportion of patients with SLI in basal ganglia was significantly higher in the depression group (65.0 versus 32.8xa0%; Pxa0<xa00.001) than in the non-depression group, and multiple prevalent factors had significant differences between the two groups. However, on multivariate logistic analysis, some of these factors were eliminated, and SLI in basal ganglia remained an independent predictor of depression with an odds ratio of 3.128 (Pxa0=xa00.018). In addition, vascular risk factors, including high body mass index level, presence of inflammation markers (e.g., CRP, TNF-α, Hs-CRP, and IL-6), and lack of physical activity, were associated with depression. Our findings suggest that SLI in basal ganglia is associated with a higher risk of depression. Vascular risk factors, which are intertwined, may propose the pathological basis of depression in SLI.

Hyperhomocysteinemia associates with small vessel disease more closely than large vessel disease.

Background: Hyperhomocysteinemia was believed to be an independent risk factor for stroke and associate with small vessel disease (SVD) related stroke and large vessel disease (LVD) related stroke differently. However its still unclear which type of stroke associated with homocysteine (HCY) more strongly because the conclusions of previous studies were contradictory. In this study we focused on the subclinical angiopathies of stroke, i.e., SVD and LVD instead of stroke subtypes and sought to compare the associations between HCY level and different angiopathies. Methods: 324 non-stroke patients were enrolled. Sex, age, HCY level and other vascular risk factors were collected. MRI and angiographies were used to determine the type of angiopathies and their severity, i.e., the scores of leukoaraiosis (LA), plaques and numbers of silent brain infarctions (SBI). LVD was defined as the presence of atherosclerotic plaques of cerebral arteries. SVD was defined as the presence of either LA or SBI. 230 patients were deemed to have LVD; 180 patients were deemed to have SVD. Spearmans correlation test and logistic regression were used to analyze the association between HCY level and different angiopathies. Results: The correlation between HCY level and scores of plaques was weaker than that of the scores of LA and numbers of SBI. Hyperhomocysteinemia was an independent risk factor for SVD (OR = 1.315, P <0.001), whereas the association between HCY level and LVD was not that significant (OR = 1.058, P = 0.075). Conclusion: HCY level associated with SVD more strongly than LVD.

A Meta-Analysis of Association between Cerebral Microbleeds and Cognitive Impairment

Background The clinical effect of cerebral microbleeds (CMBs) on cognition has been receiving much research attention, but results are often inconsistent. Material/Methods We searched PubMed, Embase, Web of Science, and some Chinese electronic databases. A total of 15 studies were included. Results Patients with CMBs had higher incidence of cognitive dysfunction (OR 3.14; 95% CI 1.66–5.92) and lower scores of cognitive function (SMD was −0.36 [−0.55, −0.18] in the MMSE group and −0.65 [−0.99, −0.32] in the MoCA [Montreal Cognitive Assessment] group). The results also indicated that a higher number of CMB lesions led to more severe cognitive dysfunction (SMD was −2.41 [−5.04, −0.21] in the mild group and −2.75 [−3.50, −2.01] in the severe group). We also found that cognitive performance was significantly impaired when CMBs were located in deep (−0.4 [−0.69, −0.11]), lobar regions (−0.50 [−0.92, −0.09]), basal ganglia (−0.72 [−1.03, −0.41]), and thalamus brain regions (−0.65 [−0.98, −0.32]). Conclusions This meta-analysis showed that CMBs were associated with cognitive dysfunction according to higher number and different locations of CMBs. Future work should focus on long-term prognosis of continuing cognitive decline and specific treatments to reduce the formation of CMBs.

Leukoaraiosis correlates with the neurologic deterioration after small subcortical infarction.

BACKGROUNDnPatients of small subcortical infarction sometimes have neurologic deterioration (ND), with the risk factors and specific pathogenesis unclear. Small subcortical infarction is often accompanied by other phenotypes of small vessel disease such as leukoaraiosis, which indicates the white matter hyperintensities in the deep or periventricular areas on the fluid-attenuated inversion recovery series of magnetic resonance images and was proved to be associated with stroke in various aspects. In this study, we intended to investigate whether leukoaraiosis was associated with ND after small subcortical infarction, and explore other possible risk factors of ND.nnnMETHODSnPatients with single acute subcortical infarction (<1.5xa0cm in diameter) were recruited consecutively and evaluated everyday. ND was defined as worsening by 2 points or more in the National Institutes Health Stroke Scale (NIHSS) score, or by 1 point or more in the NIHSS score for motor function within 1xa0week after stroke onset. Leukoaraiosis was rated according to the age-related white matter changes scale. Univariate and multivariate analyses were performed to identify the risk factors for ND.nnnRESULTSnEighty-four of 435 patients (19.31%) had ND. Univariate analysis showed that age, severity of leukoaraiosis, baseline NIHSS score, presence of diabetes, hemoglobin A1c, and total cholesterol levels were all associated with ND. Multivariate analysis further identified that the severity of leukoaraiosis especially leukoaraiosis adjacent to the index infarction, baseline NIHSS score, and diabetes were independently associated with ND.nnnCONCLUSIONSnSeverity of leukoaraiosis and baseline neurologic deficits, and the presence of diabetes were all independently associated with ND after small subcortical infarction.

Basilar artery atherosclerosis and hypertensive small vessel disease in isolated pontine infarctions: a study based on high-resolution MRI.

Background: Isolated pontine infarctions are classified as paramedian pontine infarction (PPI) and lacunar pontine infarction (LPI), usually attributed to basilar artery (BA) atherosclerosis and small vessel disease (SVD), respectively. Recently, researchers found BA atherosclerotic plaques in LPI and made the pathogenesis of LPI confusing. Methods: We evaluated the presence and location of BA plaques with high-resolution MRI and SVD burden with presence of hypertension, leukoaraiosis and silent brain infarction. Results: The prevalence of BA plaques and SVD was similar between PPI and LPI, with most plaques relevant to corresponding infarctions. Some PPI had no plaques; some LPI had no obvious SVD. Conclusion: SVD and BA plaques with or without lumen stenosis were both possible causes of PPI and LPI.

Prognostic Value of Morning Blood Pressure Surge in Clinical Events: A Meta-analysis of Longitudinal Studies

BACKGROUNDnCardiovascular (CV) events tend to occur more often in the morning. Thus, morning blood pressure surge (MS) may be related to the risk of CV events. The results of several studies evaluating the prognostic value of MS are inconsistent. In this study, we conducted a systematic review and meta-analysis to summarize the significance of MS in predicting future CV events.nnnMETHODSnAmong the related literature, we discovered 7 eligible longitudinal studies that had evaluated MS and had followed 14,133 patients with a mean follow-up period of 7.1 years. We evaluated the predictive value of MS for future CV events, stroke, and all-cause mortality in this meta-analysis.nnnRESULTSnFor subjects with higher pre-waking MS than those with lower pre-waking MS, the pooled relative risk (RR) of all-cause mortality, stroke, and total CV events were 1.20 (95% confidence interval [CI]: .85-1.70, P = .290; 4 studies), 1.20 (95% CI: .94-1.53, P = .146; 3 studies), and 1.24 (95% CI: .60-2.53, P = .562; 3 studies), respectively. For subjects with higher sleep-trough MS, the pooled RR of all-cause mortality was 1.29 (95% CI: 1.11-1.52, P = .001; 4 studies). No significant publication bias was observed.nnnCONCLUSIONSnExcess sleep-trough MS is a strong predictor for future all-cause mortality. Individuals with higher pre-waking MS showed a tendency for increased risk of CV outcomes, but the differences were insignificant.

Microbleeds in Late-Life Depression: Comparison of Early- and Late-Onset Depression

Late-life depression could be classified roughly as early-onset depression (EOD) and late-onset depression (LOD). LOD was proved to be associated with cerebral lesions including white matter hyperintensities (WMH) and silent brain infarctions (SBI), differently from EOD. However, it is unclear whether similar association is present between LOD and microbleeds which are also silent lesions. In this study, 195 patients of late-life depression were evaluated and divided into EOD, presenile-onset depression (POD), and LOD groups; 85 healthy elderly controls were enrolled as controls. Subjects were scanned by MRI including susceptibility weighted images to evaluate white matter hyperintensities (WMH), silent brain infarctions (SBI), and microbleeds. The severity of depression was evaluated with 15-item Geriatric Depression Scale. Psychosocial factors were investigated with Scale of Life Events and Lubben Social Network Scale. Logistic regression and linear regression were performed to identify the independent risk factors for depression. Results showed that LOD patients had higher prevalence of microbleeds than EOD, POD, and control patients. The prevalence of lobar microbleeds and microbleeds in the left hemisphere was the independent risk factor for the occurrence of LOD; a high number of microbleeds were associated with severe state of LOD, whereas life events and lack of social support were more important for EOD and POD. All these results indicated that Microbleeds especially lobar microbleeds and microbleeds in the left hemisphere were associated with LOD but not with EOD.

The ‘silence’ of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size

OBJECTIVE: Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their ‘silence; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this ‘silence. METHODS: In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. RESULTS: The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. CONCLUSIONS: Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the ‘silence of silent brain infarctions.

Microbleeds and Silent Brain Infarctions Are Differently Associated with Cognitive Dysfunction in Patients with Advanced Periventricular Leukoaraiosis

Background Leukoaraiosis, microbleeds, and silent brain infarctions are phenotypes of small vessel disease. Leukoaraiosis is the most prevalent, and advanced periventricular leukoaraiosis is regarded as a strong predictor of cognitive dysfunction. Microbleeds and silent brain infarctions sometimes coexist with leukoaraiosis. This study aims to analyze the effects of microbleeds and silent brain infarctions on cognitive function of patients with advanced periventricular leukoaraiosis. Methods 227 patients with advanced periventricular leukoaraiosis were divided into control, MB, SBI, and MB&SBI groups. The presence and locations of microbleeds and silent brain infarctions were evaluated. Mini-Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test and Verbal Fluency Test were performed. Chi-square test and ANOVA to compare the characteristics of four groups, multiple linear regressions to identify the risk factors for cognitive dysfunction. Results The scores in all four tests were lower in the MB and MB&SBI groups while only the scores in Clock Drawing Test and Verbal Fluency Test were lower in the SBI group than in the control group. Age and the presence of microbleeds were independent risk factors for the lower scores in all four tests, whereas the presence of silent brain infarctions was the only independent risk factor for the lower scores in Clock Drawing Test and Verbal Fluency Test. Lobar microbleeds had the most significant effect on cognitive function. Conclusion Microbleeds and silent brain infarctions were associated differently with cognitive impairment of patients with advanced periventricular leukoaraiosis. The effect of lobar microbleeds was the most significant.