Background White matter hyperintensity(WMH)progression is well documented;WMH regression is more contentious,which might reflect differences in defining WMH change.We compared four existing WMH change definitions in o...Background White matter hyperintensity(WMH)progression is well documented;WMH regression is more contentious,which might reflect differences in defining WMH change.We compared four existing WMH change definitions in one population to determine the effect of definition on WMH regression.Methods We recruited patients with minor non-disabling ischaemic stroke who underwent MRI 1-3 months after stroke and 1 year later.We assessed WMH volume(in absolute mL and%intracranial volume)and applied four different definitions,including two thresholds(based on SD or mL),percentile and quintile approaches.Results In 198 participants,mean age 65.5(SD=11.13),baseline WMH volume was 15.46 mL(SD=19.2),the mean net WMH volume change was 0.98 mL(SD=2.84),range-7.98 to+12.84 mL.Proportion regressing/stable/progressing WMH were threshold 1(SD),29.8%/55.6%/14.6%;threshold 2(mL),29.8%/16.7%/53.5%;percentile approach,28.3%/21.2%/50.5%.The quintile approach includes five groups with quintile 3 reflecting no change(N=40),quintiles 1 and 2 any WMH decrease(N=80)and quintiles 4 and 5 any WMH increase(N=78).Conclusions Different WMH change definitions cause big differences in how participants are categorised;additionally,non-normal WMH distribution precludes use of some definitions.Consistent use of an appropriate definition would facilitate data comparisons,particularly in clinical trials of potential WMH treatments.展开更多
Cerebral small vessel disease(SVD)is a common global brain disease that causes cognitive impairment,ischemic or hemorrhagic stroke,problems with mobility,and neuropsychiatric symptoms.The brain damage,seen as focal wh...Cerebral small vessel disease(SVD)is a common global brain disease that causes cognitive impairment,ischemic or hemorrhagic stroke,problems with mobility,and neuropsychiatric symptoms.The brain damage,seen as focal white and deep grey matter lesions on brain magnetic resonance imaging(MRI)or computed tomography(CT),typically accumulates"covertly"and may reach an advanced state before being detected incidentally on brain scanning or causing symptoms.Patients have typically presented to different clinical services or been recruited into research focused on one clinical manifestation,perhaps explaining a lack of awareness,until recently,of the full range and complexity of SVD.In this review,we discuss the varied clinical presentations,established and emerging risk factors,relationship to SVD features on MRI or CT,and the current state of knowledge on the effectiveness of a wide range of pharmacological and lifestyle interventions.The core message is that effective assessment and clinical management of patients with SVD,as well as future advances in diagnosis,care,and treatment,will require a more"joined-up"’approach.This approach should integrate clinical expertise in stroke neurology,cognitive,and physical dysfunctions.It requires more clinical trials in order to improve pharmacological interventions,lifestyle and dietary modifications.A deeper understanding of the pathophysiology of SVD is required to steer the identification of novel interventions.An essential prerequisite to accelerating clinical trials is to improve the consistency,and standardization of clinical,cognitive and neuroimaging endpoints.展开更多
基金Supported by the UK Dementia Research Institute[award number UK DRI-4002]through UK DRI Ltd.Principally funded by the UK Medical Research Council(ACCJ,CA,DJG,JMW)The Row Fogo Centre for Research into Aging and the Brain(ACCJ,CA,DJG,MVH,JMW)+12 种基金the Fondation Leducq Network(16 CVD 05)Stroke Association‘Small Vessel Disease-Spotlight on Symptoms(SVD-SOS)’(SAPG 19n100068)British Heart Foundation(RE/18/5/34216)Alzheimer’s Society(ref 486(AS-CP 18b 001))University of Edinburgh College of Medicine and Veterinary Medicine(ACCJ)Wellcome trust(DJG).Biotechnology and Biological Sciences Research Council,and the Economic and Social Research Council(BB/W008793/1SMM)The Scottish Chief Scientist Office(CAF/18/08UC)Mexican National Council of Science and Technology(CONACYT,2021-000007-01EXTF 00234)the Rowling Clinic(CA).NHS Lothian Research and Development Office(MJT)The Stroke Association(SA PDF 18\100026,SA PDF 23\100007,TSA LECT 2015/04,16 VAD 07SW,MSS,FND).
文摘Background White matter hyperintensity(WMH)progression is well documented;WMH regression is more contentious,which might reflect differences in defining WMH change.We compared four existing WMH change definitions in one population to determine the effect of definition on WMH regression.Methods We recruited patients with minor non-disabling ischaemic stroke who underwent MRI 1-3 months after stroke and 1 year later.We assessed WMH volume(in absolute mL and%intracranial volume)and applied four different definitions,including two thresholds(based on SD or mL),percentile and quintile approaches.Results In 198 participants,mean age 65.5(SD=11.13),baseline WMH volume was 15.46 mL(SD=19.2),the mean net WMH volume change was 0.98 mL(SD=2.84),range-7.98 to+12.84 mL.Proportion regressing/stable/progressing WMH were threshold 1(SD),29.8%/55.6%/14.6%;threshold 2(mL),29.8%/16.7%/53.5%;percentile approach,28.3%/21.2%/50.5%.The quintile approach includes five groups with quintile 3 reflecting no change(N=40),quintiles 1 and 2 any WMH decrease(N=80)and quintiles 4 and 5 any WMH increase(N=78).Conclusions Different WMH change definitions cause big differences in how participants are categorised;additionally,non-normal WMH distribution precludes use of some definitions.Consistent use of an appropriate definition would facilitate data comparisons,particularly in clinical trials of potential WMH treatments.
基金This work is supported by the UK Dementia Research Institute(JMW,CA)which receives its funding from DRI Ltd,funded by the UK MRC,Alzheimer's Society and Alzheimer's Research UKthe Fondation Leducq Network for the Study of Perivascular Spaces in Small Vessel Disease(JMW,16 CVD 05)+12 种基金The European Union Horizon 2020,SVDs@Target(JMW,FD,PHC-03-15,project No 666881)The Row Fogo Charitable Trust Centre for Research into Aging and the Brain(JMW)The British Heart Foundation(LACI-2 and Centre for Research Excellence,CS/15/5/31475,RE/18/5/34216)The Chief Scientist Office of Scotland(CZB/4/281,ETM/326,and Clinical Academic Fellowship UC,CAF/18/08)Chest Heart Stroke Scotland(Resl4/A157)NHS Research Scotland(FND)Stroke Association(Garfield Weston Foundation Senior Clinical Lectureship FND,TSALECT 2015/04‘Small Vessel Disease-Spotlight on Symptoms,FD,JMW,UC,SVD-SOSSAPG 19\100068R4VaD,JMW,FD,PMB,16 VAD 07Princess Margaret Research Development Fellowship,UC,2018Stroke Association Professor of Stroke Medicine PMB)PMB is a NIHR Senior Investigator.
文摘Cerebral small vessel disease(SVD)is a common global brain disease that causes cognitive impairment,ischemic or hemorrhagic stroke,problems with mobility,and neuropsychiatric symptoms.The brain damage,seen as focal white and deep grey matter lesions on brain magnetic resonance imaging(MRI)or computed tomography(CT),typically accumulates"covertly"and may reach an advanced state before being detected incidentally on brain scanning or causing symptoms.Patients have typically presented to different clinical services or been recruited into research focused on one clinical manifestation,perhaps explaining a lack of awareness,until recently,of the full range and complexity of SVD.In this review,we discuss the varied clinical presentations,established and emerging risk factors,relationship to SVD features on MRI or CT,and the current state of knowledge on the effectiveness of a wide range of pharmacological and lifestyle interventions.The core message is that effective assessment and clinical management of patients with SVD,as well as future advances in diagnosis,care,and treatment,will require a more"joined-up"’approach.This approach should integrate clinical expertise in stroke neurology,cognitive,and physical dysfunctions.It requires more clinical trials in order to improve pharmacological interventions,lifestyle and dietary modifications.A deeper understanding of the pathophysiology of SVD is required to steer the identification of novel interventions.An essential prerequisite to accelerating clinical trials is to improve the consistency,and standardization of clinical,cognitive and neuroimaging endpoints.
