Imaging markers of incipient dementia The white matter matters

Correspondence & reprint requests to Dr. Carmichael: .
Neurology (Impact Factor: 8.29). 07/2012; 79(8):726-7. DOI: 10.1212/WNL.0b013e3182662020
Source: PubMed


Dementia researchers are struggling to clarify the clinical relevance of a brain imaging finding that is common among cognitively healthy elderly individuals.(1) It is associated with increased risk of clinical dementia,(2) but the time course of this progression is not fully understood. It may begin to occur as early as the fifth or sixth decade of life(3) and may persist for many years before clinical symptoms become apparent. There are good reasons to believe that the neurobiological events giving rise to this imaging finding are deleterious. However, it is currently not known whether prevention or reversal of these events is sufficient to prevent a cascade of brain injury processes that eventually culminates in clinical dementia.

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    • "The implication from these studies and reviews is that overlapping trauma-induced neurodegenerative effects occur within the same frontotemporolimbic areas associated with age-related neurodegenerative disorders. This association between TBI and later onset of dementia may also relate to the selective WM damage that occurs with TBI and the role that WM pathology plays in the expression of dementia via a breakdown in neural connectivity and networks (Carmichael and Salloway, 2012; Shively et al., 2012; Weinstein et al., 2013). "
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    ABSTRACT: Depending on severity, traumatic brain injury (TBI) induces immediate neuropathological effects that in the mildest form may be transient but as severity increases results in neural damage and degeneration. The first phase of neural degeneration is explainable by the primary acute and secondary neuropathological effects initiated by the injury; however, neuroimaging studies demonstrate a prolonged period of pathological changes that progressively occur even during the chronic phase. This review examines how neuroimaging may be used in TBI to understand (1) the dynamic changes that occur in brain development relevant to understanding the effects of TBI and how these relate to developmental stage when the brain is injured, (2) how TBI interferes with age-typical brain development and the effects of aging thereafter, and (3) how TBI results in greater frontotemporolimbic damage, results in cerebral atrophy, and is more disruptive to white matter neural connectivity. Neuroimaging quantification in TBI demonstrates degenerative effects from brain injury over time. An adverse synergistic influence of TBI with aging may predispose the brain injured individual for the development of neuropsychiatric and neurodegenerative disorders long after surviving the brain injury.
    Frontiers in Human Neuroscience 08/2013; 7:395. DOI:10.3389/fnhum.2013.00395 · 3.63 Impact Factor
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    ABSTRACT: Prior to intervention trials in individuals genetically at-risk for late-onset Alzheimer's disease, critical first steps are identifying where (neuroanatomic effects), when (timepoint in the lifespan) and how (gene expression and neuropathology) Alzheimer's risk genes impact the brain. We hypothesized that variants in the sortilin-like receptor (SORL1) gene would affect multiple Alzheimer's phenotypes before the clinical onset of symptoms. Four independent samples were analyzed to determine effects of SORL1 genetic risk variants across the lifespan at multiple phenotypic levels: (1) microstructural integrity of white matter using diffusion tensor imaging in two healthy control samples (n=118, age 18-86; n=68, age 8-40); (2) gene expression using the Braincloud postmortem healthy control sample (n=269, age 0-92) and (3) Alzheimer's neuropathology (amyloid plaques and tau tangles) using a postmortem sample of healthy, mild cognitive impairment (MCI) and Alzheimer's individuals (n=710, age 66-108). SORL1 risk variants predicted lower white matter fractional anisotropy in an age-independent manner in fronto-temporal white matter tracts in both samples at 5% family-wise error-corrected thresholds. SORL1 risk variants also predicted decreased SORL1 mRNA expression, most prominently during childhood and adolescence, and significantly predicted increases in amyloid pathology in postmortem brain. Importantly, the effects of SORL1 variation on both white matter microstructure and gene expression were observed during neurodevelopmental phases of the human lifespan. Further, the neuropathological mechanism of risk appears to primarily involve amyloidogenic pathways. Interventions targeted toward the SORL1 amyloid risk pathway may be of greatest value during early phases of the lifespan.Molecular Psychiatry advance online publication, 29 October 2013; doi:10.1038/mp.2013.142.
    Molecular Psychiatry 10/2013; 19(10). DOI:10.1038/mp.2013.142 · 14.50 Impact Factor