Neuroimaging Correlates of Memory Decline Following Carotid Interventions

颈动脉干预后记忆力下降的神经影像学相关性

• 批准号: 8548425
• 负责人: ALLYSON C ROSEN
• 金额: $ 14.05万
• 依托单位: PALO ALTO VETERANS INSTIT FOR RESEARCH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8548425
• 关键词: Adult; Alzheimer' s Disease; Anisotropy; Area; Awareness; Brain; Brain imaging; Carotid Endarterectomy; Cerebrovascular Circulation; Clinical; Clinical Research; Cognitive; Complication; Conflict (Psychology); Data; Dementia; Deterioration; Diffusion; Diffusion Magnetic Resonance Imaging; Disease; Elderly; Etiology; Evaluation; Frequencies; Funding; Future; Goals; Healthcare; Imaging Techniques; Impaired cognition; Incidence; Intervention; Learning; Lesion; Location; Magnetic Resonance Imaging; Maps; Measurement; Measures; Memory; Modeling; Morus; Neurologic; Operative Surgical Procedures; Outcome; Parents; Patient Care; Patients; Perfusion; Postoperative Period; Procedures; Protocols documentation; Public Health; Recruitment Activity; Research; Research Infrastructure; Research Personnel; Research Project Grants; Resources; Risk; Risk Factors; Societies; Spin Labels; Stroke; Stroke prevention; Structure; Subgroup; Symptoms; Techniques; Testing; United States National Institutes of Health; Vascular Diseases; analytical tool; base; care burden; cognitive change; cognitive function; cohort; density; digital; effective therapy; experience; hemodynamics; improved; morphometry; multidisciplinary; neuroimaging; neuropsychological; novel; prevent; procedural memory; white matter

DESCRIPTION (provided by applicant): Memory decline is one of the earliest symptoms of Alzheimer's disease and there is a growing awareness that vascular disease can accelerate the course of decline for this dementia. Whereas both carotid endarterectomy (CEA) and carotid stenting (CAS) are effective treatments for stroke prevention in patients with severe carotid occlusive diseases, recent studies suggest that approximately a quarter of elderly adults undergoing these procedures experience cognitive decline. Our recently funded NIH project is to study memory decline with the goal of relating cognitive changes to microembolic lesions that occur during or after carotid intervention (R01 NS070308). The ultimate goal of that R01 is to identify the aspects of the surgical procedures and patient factors that increase the risk of cognitive decline so that they can be prevented. The research from that project led to the current proposal. Using a novel neuroimaging approach, we performed volumetric analysis of microemboli that were documented on post-procedural MRIs and generated a digital map of microemboli. This map remarkably resembled the general location of hemodynamic risk zone (HRZ). We have also shown decreased white matter (WM) density in these areas vulnerable to microemboli among the patients who had post-procedural memory decline. Based on our preliminary evaluations, we believe that reduced cerebral blood flow (CBF), decreased brain WM integrity, and procedure-related microembolization are intimately related. We propose a novel concept of a single model integrating all three risk factors for procedure-related cognitive deterioration. We hypothesize that brain white matter abnormality and cerebral blood flow reduction in HRZ contribute to the frequency and cognitive effects of microemboli. In this proposal, we will add diffusion tensor imaging (DTI) to evaluate white matter integrity and arterial spin labeling (ASL) to evaluate cerebral blood flow. We will first determine the effects o white matter abnormality in HRZ on carotid interventions-associated microemboli and cognitive changes; we will also examine the effects of CBF on procedure-associated microemboli and cognitive change. Through advanced neuroimaging techniques and novel analytical tools, we hope to identify a subset of patients at risk for procedure-associated cognitive deterioration. Thi proposal reflects our continuous efforts to improve interventional outcomes. Complementary to our NIH R01, this proposal will help to better understand the underlying etiology of cognitive deterioration following carotid revascularization and will potentially help to improve cognitive outcome by individualizing patient care.

描述（由申请人提供）：记忆衰退是阿尔茨海默病的最早症状之一，人们越来越意识到血管疾病会加速这种痴呆症的衰退过程。虽然颈动脉内膜切除术 (CEA) 和颈动脉支架置入术 (CAS) 都是预防严重颈动脉闭塞性疾病患者中风的有效治疗方法，但最近的研究表明，大约四分之一接受这些手术的老年人会出现认知能力下降。我们最近资助的 NIH 项目是研究记忆力下降，目标是将认知变化与颈动脉介入期间或之后发生的微栓塞病变联系起来 (R01 NS070308)。 R01 的最终目标是确定增加认知能力下降风险的外科手术和患者因素的各个方面，以便预防这些情况。该项目的研究得出了当前的提案。使用一种新颖的神经影像方法，我们对术后 MRI 上记录的微栓子进行了体积分析，并生成了微栓子的数字图。该地图与血流动力学危险区 (HRZ) 的大致位置非常相似。我们还发现，在术后记忆力下降的患者中，这些易受微栓子影响的区域的白质（WM）密度降低。根据我们的初步评估，我们认为脑血流量 (CBF) 减少、脑 WM 完整性降低以及手术相关的微栓塞密切相关。我们提出了一个单一模型的新概念，整合了与手术相关的认知恶化的所有三个风险因素。我们假设脑白质异常和 HRZ 脑血流量减少导致微栓塞的发生频率和认知效应。在本提案中，我们将添加弥散张量成像（DTI）来评估白质完整性，并添加动脉自旋标记（ASL）来评估脑血流。我们将首先确定HRZ白质异常对颈动脉干预相关的微栓塞和认知变化的影响；我们还将研究 CBF 对手术相关微栓塞和认知变化的影响。通过先进的神经影像技术和新颖的分析工具，我们希望识别出存在与手术相关的认知恶化风险的患者子集。该提案反映了我们为改善干预结果所做的持续努力。作为 NIH R01 的补充，该提案将有助于更好地了解颈动脉血运重建后认知恶化的根本病因，并可能有助于通过个体化患者护理来改善认知结果。