Jose Gutierrez1,2, Tiffany N Porras3, Moka Yoo-Jeong4, Farid Khasiyev5, Kay C Igwe1, Krystal K Laing1, Adam M Brickman1,2,6, Marykay Pavol1, Rebecca Schnall7,8. 1. Department of Neurology, Columbia University Irving Medical Center, New York, NY. 2. Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY. 3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY. 4. School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA. 5. Department of Neurology, Saint Louis University, Saint Louis, MI. 6. Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY. 7. School of Nursing, Columbia University Irving Medical Center, New York, NY; and. 8. Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY.
Abstract
BACKGROUND: To investigate a comprehensive array of magnetic resonance imaging (MRI)-based biomarkers of cerebrovascular disease (CVD) in a cohort of people living with HIV (PLWH) and relate these imaging biomarkers to cognition. SETTINGS: Cross-sectional, community-based study. METHODS: Participants were PLWH in New York City, aged 50 years or older. They underwent a brain magnetic resonance angiography or MRI to ascertain 7 MRI markers of CVD: silent brain infarcts, dilated perivascular spaces, microhemorrhages, white matter hyperintensity volume, white matter fractional anisotropy and mean diffusivity (measures of white matter integrity), and intracranial large artery stenosis. Participants underwent a battery of neurocognitive tests to obtain individual and global cognitive scores representative of various aspects of cognition. RESULTS: We included 85 participants (mean age 60 ± 6 years, 48% men, 78% non-Hispanic Black), most of them with well-controlled HIV (75% with CD4 cell count > 200 cells/mm3 and viral load < 400 copies/mL at or near the time of the MRI scan). Silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity were associated with poorer performance in at least one cognitive domain, but the sum of these 3 MRI markers of CVD was associated with lower working memory (B = -0.213, P = 0.028), list learning (B = -0.275, P = 0.019), and global cognition (B = -0.129, P = 0.007). CONCLUSIONS: We identified silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity as exposures that may be modifiable and may, therefore, influence cognitive decline. In addition, these MRI markers of CVD may help in identifying PLWH at higher risk of cognitive decline, which may be more amenable to targeted therapies.
BACKGROUND: To investigate a comprehensive array of magnetic resonance imaging (MRI)-based biomarkers of cerebrovascular disease (CVD) in a cohort of people living with HIV (PLWH) and relate these imaging biomarkers to cognition. SETTINGS: Cross-sectional, community-based study. METHODS: Participants were PLWH in New York City, aged 50 years or older. They underwent a brain magnetic resonance angiography or MRI to ascertain 7 MRI markers of CVD: silent brain infarcts, dilated perivascular spaces, microhemorrhages, white matter hyperintensity volume, white matter fractional anisotropy and mean diffusivity (measures of white matter integrity), and intracranial large artery stenosis. Participants underwent a battery of neurocognitive tests to obtain individual and global cognitive scores representative of various aspects of cognition. RESULTS: We included 85 participants (mean age 60 ± 6 years, 48% men, 78% non-Hispanic Black), most of them with well-controlled HIV (75% with CD4 cell count > 200 cells/mm3 and viral load < 400 copies/mL at or near the time of the MRI scan). Silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity were associated with poorer performance in at least one cognitive domain, but the sum of these 3 MRI markers of CVD was associated with lower working memory (B = -0.213, P = 0.028), list learning (B = -0.275, P = 0.019), and global cognition (B = -0.129, P = 0.007). CONCLUSIONS: We identified silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity as exposures that may be modifiable and may, therefore, influence cognitive decline. In addition, these MRI markers of CVD may help in identifying PLWH at higher risk of cognitive decline, which may be more amenable to targeted therapies.
Authors: J D Curb; S L Pressel; J A Cutler; P J Savage; W B Applegate; H Black; G Camel; B R Davis; P H Frost; N Gonzalez; G Guthrie; A Oberman; G H Rutan; J Stamler Journal: JAMA Date: 1996-12-18 Impact factor: 56.272
Authors: Jose Gutierrez; James Goldman; Andrew J Dwork; Mitchell S V Elkind; Randolph S Marshall; Susan Morgello Journal: Neurology Date: 2015-08-28 Impact factor: 9.910
Authors: Walter Kalback; Chera Esh; Eduardo M Castaño; Afroza Rahman; Tyler Kokjohn; Dean C Luehrs; Lucia Sue; Raquel Cisneros; Francoise Gerber; Claudia Richardson; Bernd Bohrmann; Douglas G Walker; Thomas G Beach; Alex E Roher Journal: Neurol Res Date: 2004-07 Impact factor: 2.448