Juha O Rinne

University of Helsinki, Helsinki, Uusimaa, Finland

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Publications (485)2200.39 Total impact

  • J. Rinne · T. Karl · A. Guenther

    No preview · Article · Feb 2016
  • Laura Airas · Eero Rissanen · Juha O. Rinne
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    ABSTRACT: Conventional MR imaging (MRI) techniques form the cornerstone of multiple sclerosis (MS) diagnostics and clinical follow-up today. MRI is sensitive in demonstrating focal inflammatory lesions and diffuse atrophy. However, especially in progressive MS, there is increasingly widespread diffuse pathology also outside the plaques, often related to microglial activation and neurodegeneration. This cannot be detected using conventional MRI. Positron emission tomography (PET) imaging using 18-kDa translocator protein (TSPO) binding radioligands has recently shown promise as a tool to detect this diffuse pathology in vivo, and for the first time allows one to follow its development longitudinally. It is becoming evident that the more advanced the MS disease is, the more pronounced is microglial activation. PET imaging allows the detection of MS-related pathology at molecular level in vivo. It has potential to enable measurement of effects of new disease-modifying drugs aimed at reducing neurodegeneration and neuroinflammation. PET imaging could thus be included in the design of future clinical trials of progressive MS. There are still technical issues related to the quality of TSPO radioligands and post-processing methodology, and comparison of studies from different PET centres is challenging. In this review, we summarise the main evidence supporting the use of TSPO-PET as a tool to explore the diffuse inflammation in MS.
    No preview · Article · Oct 2015
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    ABSTRACT: Objectives: To define CSF β-amyloid 1-42 (Aβ42) cutpoints to detect cortical amyloid deposition as assessed by (11)C-Pittsburgh compound B ([(11)C]PiB)-PET and to compare these calculated cutpoints with cutpoints currently used in clinical practice. Methods: We included 433 participants (57 controls, 99 with mild cognitive impairment, 195 with Alzheimer disease [AD] dementia, and 82 with non-AD dementia) from 5 European centers. We calculated for each center and for the pooled cohort CSF Aβ42 and Aβ42/tau ratio cutpoints for cortical amyloid deposition based on visual interpretation of [(11)C]PiB-PET images. Results: Amyloid-PET-based calculated CSF Aβ42 cutpoints ranged from 521 to 616 pg/mL, whereas existing clinical-based cutpoints ranged from 400 to 550 pg/mL. Using the calculated cutpoint from the pooled sample (557 pg/mL), concordance between CSF Aβ42 and amyloid-PET was 84%. Similar concordance was found when using a dichotomized Aβ42/tau ratio. Exploratory analysis showed that participants with a positive amyloid-PET and normal CSF Aβ42 levels had higher CSF tau and phosphorylated tau levels and more often had mild cognitive impairment or AD dementia compared with participants who had negative amyloid-PET and abnormal CSF Aβ42 levels. Conclusions: Amyloid-PET-based CSF Aβ42 cutpoints were higher and tended to reduce intercenter variability compared with clinical-based cutpoints. Discordant participants with normal CSF Aβ42 and a positive amyloid-PET may be more likely to have AD-related amyloid pathology than participants with abnormal CSF Aβ42 and a negative amyloid-PET. Classification of evidence: This study provides Class II evidence that an amyloid-PET-based CSF Aβ42 cutpoint identifies individuals with amyloid deposition with a sensitivity of 87% and specificity of 80%.
    Full-text · Article · Oct 2015 · Neurology
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    ABSTRACT: Recently, the number and amount of biogenically emitted volatile organic compounds (VOCs) has been discussed vigorously. Depending on the ecosystem the published number varies between a dozen and several hundred compounds. We present ecosystem exchange fluxes from a mixed oak-hornbeam forest in the Po Valley, Italy. The fluxes were measured by a proton transfer reaction-time-of-flight (PTR-ToF) mass spectrometer and calculated by the eddy covariance (EC) method. Detectable fluxes were observed for twelve compounds, dominated by isoprene, which comprised over 65 % of the total flux emission. The daily average of the total VOC emission was 9.5 nmol m-2 s-1. Methanol had the highest concentration and accounted for the largest deposition. Methanol seemed to be deposited to dew, as the deposition happened in the early morning, right after the calculated surface temperature came closest to the calculated dew point temperature. We estimated that up to 27 % of the upward flux of methyl vinyl ketone (MVK) and methacrolein (MACR) originated from atmospheric oxidation of isoprene. A comparison between two flux detection methods (classical/visual and automated) was made. Their respective advantages and disadvantages were discussed and the differences in their results shown. Both provide comparable results; however we recommend the automated method with a compound filter, which combines the fast analysis and better flux detection, without the overestimation due to double counting.
    No preview · Article · Oct 2015 · Atmospheric Chemistry and Physics
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    L. Airas · E. Rissanen · J. Tuisku · M. Gardberg · J.O. Rinne

    Preview · Article · Oct 2015
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    ABSTRACT: Objective: To study the impact of childhood-onset epilepsy on a variety of outcomes across the life span. Methods: A population-based cohort of 245 subjects with childhood-onset epilepsy was assessed for outcomes at 45 years. In addition, 51 of 78 surviving subjects with uncomplicated epilepsy and 52 of 99 originally matched controls participated in a detailed evaluation including electroencephalography (EEG), imaging, and laboratory studies at 50 years. Results: Of 179 surviving subjects, 61% were in terminal 10-year remission and 43% in remission off medications. At 45 years, 95% of the idiopathic group, 72% of the cryptogenic group, and 47% of the remote symptomatic group were in terminal remission (p < 0.001). Abnormal neurologic signs were significantly more common in subjects with uncomplicated epilepsy than in controls. Mortality during period 1992-2012 was higher in subjects than in controls (9% vs. 1%, p = 0.02). The rate of 3T MRI abnormalities was higher in subjects than in controls (risk ratio [RR] 2.0; 1.3-3.1) specifically including findings considered markers of cerebrovascular disease (RR 2.5; 1.04-5.9). Even subjects with idiopathic epilepsy had higher rates of imaging abnormalities than controls (73% vs. 34%, p = 0.002). Significance: Long-term seizure outcomes are excellent and a function of etiology. The presence of imaging abnormalities suggestive of vascular disease may put these subjects at higher risk for clinically evident stroke and cognitive changes as they age.
    Full-text · Article · Oct 2015 · Epilepsia
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    ABSTRACT: The aim of this longitudinal positron emission tomography (PET) study was to evaluate the interrelationship between brain metabolism and amyloid accumulation during the disease process from mild cognitive impairment (MCI) to Alzheimer's disease (AD). Nine MCI patients, who converted to AD between two and five years, and nine healthy subjects underwent [11C]PIB and [18F]FDG PET scans at baseline and at 5 years. [11C]PIB uptake was clearly higher in MCI patients at baseline compared to controls and spread extensively to the cerebral cortex during the conversion to AD. [18F]FDG uptake was reduced especially in the temporal-parietal regions in MCI compared to controls at baseline, and widely over the cortex at the 5-year follow-up. The reduction in metabolism during the follow-up was significant in the posterior brain regions. In addition, brain amyloid load was positively associated with metabolism in posterior brain regions in MCI, but not after conversion to AD. The results suggest that there are interactions between brain amyloid accumulation and metabolism during the AD process, including a possible compensatory upregulation of posterior brain metabolism in the early phase.
    No preview · Article · Sep 2015 · Journal of Alzheimer's disease: JAD
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    ABSTRACT: Background: The pathophysiology of the movement disorder progressive ataxia with palatal tremor (PAPT) is unclear. Case report: A 77-year-old male presented with dysarthria, ataxia, and 1-2 Hz palatal tremor. A diagnosis of probable sporadic PAPT was established. Brain magnetic resonance imaging was normal at the presymptomatic phase but later showed olivary hypertrophy. Brain [(18)F]-fludeoxyglucose (FDG) positron emission tomography (PET) showed bilateral hypermetabolism in the olivary nuclei. Discussion: This second reported patient with PAPT and FDG-PET shows that olivary hypertrophy is paralleled with hypermetabolism. The olivary nuclei pathology also appears to be temporally associated with symptom onset.
    Preview · Article · Sep 2015
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    ABSTRACT: Objectives We set to investigate the possible role of genes and environment in developing Alzheimer's disease (AD) in monozygotic twin pairs discordant for AD.Methods Three pairs of twins discordant for AD, who were enrolled in the Finnish Twin Cohort, were used in the study and compared with 13 controls. Gray matter changes were assessed with magnetic resonance images using voxel-based morphometry with statistical parametric mapping.ResultsIn the affected twins, the peaks of volume loss were located bilaterally in the temporal (including the hippocampus), the frontal, and the parietal lobes, while in the unaffected siblings, the peaks were located in the frontal gyri and in the parietal lobule. Thus, in the unaffected twins, the pattern of volume loss overlaps with the neocortical but not with the medial temporal areas.DiscussionThese findings suggest that genetic factors more largely control neocortical regions, whereas environmental factors more strongly affect medial temporal regions.
    Full-text · Article · Sep 2015 · Acta Neurologica Scandinavica
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    ABSTRACT: Type 2 diabetes is an independent risk factor for cognitive decline. Insulin resistance occurring during midlife may increase the risk of cognitive decline later in life. We hypothesised that insulin resistance is associated with poorer cognitive performance and that sex and APOE*E4 might modulate this association. The association of insulin resistance and APOE*E4 genotype on cognitive function was evaluated in a nationwide Finnish population-based study (n = 5,935, mean age 52.5 years, range 30-97 years). HOMA-IR was used to measure insulin resistance. Cognitive function was tested by word-list learning, word-list delayed-recall, categorical verbal fluency and simple and visual-choice reaction-time tests. Linear regression analysis was used to determine the association between HOMA-IR and the results of the cognitive tests. Higher HOMA-IR was associated with poorer verbal fluency in women (p < 0.0001) but not in men (p = 0.56). Higher HOMA-IR was also associated with poorer verbal fluency in APOE*E4 -negative individuals (p = 0.0003), but not in APOE*E4 carriers (p = 0.28). Furthermore, higher HOMA-IR was associated with a slower simple reaction time in the whole study group (p = 0.02). To our knowledge, this is the first comprehensive, population-based study, including both young and middle-aged adults, to report that female sex impacts the association of HOMA-IR with verbal fluency. Our study was cross-sectional, so causal effects of HOMA-IR on cognition could not be evaluated. However, our results suggest that HOMA-IR could be an early marker for an increased risk of cognitive decline in women.
    No preview · Article · Aug 2015 · Diabetologia
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    ABSTRACT: The turbulence within and immediately above a vegetation canopy is the driver of the exchange processes of heat, trace gases and particles between the soil, the plants and the atmosphere above.
    Full-text · Chapter · Jul 2015
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    ABSTRACT: Volatile organic compounds (VOC) are a relatively minor component of the atmosphere and yet are widely recognized to have important roles in air quality and climate. With the exception of methane, an important greenhouse gas, atmospheric VOC are primarily of interest because of their impact on other atmospheric constituents, including oxidants and aerosol. Most of the global annual VOC emission is from biogenic sources but biomass burning, fossil fuel combustion and industrial activities dominate in some regions. Each of these major sources can be further categorized, e.g., biogenic sources include plant chloroplasts, plant specialized tissues, microbes, and animals. The processes for removing VOC from the atmosphere include VOC surface deposition, VOC deposition to particles, and surface deposition of their oxidation products including oxidized VOC, CO and CO2. Regional to global atmospheric chemistry and transport models (CTMs) routinely include at least some VOC emission and removal processes but in a highly simplified form. Climate models have previously included just methane but as they evolve into more comprehensive earth system models, other VOC are being included although the sources and sinks may be prescribed or highly simplified.
    Full-text · Chapter · Jul 2015
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    ABSTRACT: Impaired mitochondrial function, oxidative stress and formation of excessive levels of reactive oxygen species play a key role in neurodegeneration in Parkinson's disease. Myeloperoxidase is a reactive oxygen generating enzyme and is expressed by microglia. The novel compound AZD3241 is a selective and irreversible inhibitor of myeloperoxidase. The hypothesized mechanism of action of AZD3241 involves reduction of oxidative stress leading to reduction of sustained neuroinflammation. The purpose of this phase 2a randomized placebo controlled multicentre positron emission tomography study was to examine the effect of 8 weeks treatment with AZD3241 on microglia in patients with Parkinson's disease. Parkinson patients received either AZD3241 600 mg orally twice a day or placebo (in 3:1 ratio) for 8 weeks. The binding of (11)C-PBR28 to the microglia marker 18 kDa translocator protein, was examined using positron emission tomography at baseline, 4 weeks and 8 weeks. The outcome measure was the total distribution volume, estimated with the invasive Logan graphical analysis. The primary statistical analysis examined changes in total distribution volume after treatment with AZD3241 compared to baseline. Assessments of safety and tolerability of AZD3241 included records of adverse events, vital signs, electrocardiogram, and laboratory tests. The patients had a mean age of 62 (standard deviation = 6) years; 21 were male, three female and mean Unified Parkinson's Disease Rating Scale III score (motor examination) ranged between 6 and 29. In the AD3241 treatment group (n = 18) the total distribution volume of (11)C-PBR28 binding to translocator protein was significantly reduced compared to baseline both at 4 and 8 weeks (P < 0.05). The distribution volume reduction across nigrostriatal regions at 8 weeks ranged from 13-16%, with an effect size equal to 0.5-0.6. There was no overall change in total distribution volume in the placebo group (n = 6). AZD3241 was safe and well tolerated. The reduction of (11)C-PBR28 binding to translocator protein in the brain of patients with Parkinson's disease after treatment with AZD3241 supports the hypothesis that inhibition of myeloperoxidase has an effect on microglia. The results of the present study provide support for proof of mechanism of AZD3241 and warrant extended studies on the efficacy of AZD3241 in neurodegenerative disorders. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    No preview · Article · Jul 2015 · Brain

  • No preview · Article · Jul 2015
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    ABSTRACT: Long-term flux measurements of volatile organic compounds (VOC) over boreal forests are rare, although the forests are known to emit considerable amounts of VOCs into the atmosphere. Thus, we measured fluxes of several VOCs and oxygenated VOCs over a Scots pine dominated boreal forest semi-continuously between May 2010 and December 2013. The VOC profiles were obtained with a proton-transfer-reaction mass-spectrometry, and the fluxes were calculated using vertical concentration profiles and the surface layer profile method connected to the Monin-Obukhov similarity theory. In total fluxes that differed significantly from zero on a monthly basis were observed for 14 out 27 measured masses. Monoterpenes had the highest net emission in all seasons and statistically significant positive fluxes were detected from March until November. Other important compounds emitted were methanol, ethanol/formic acid, acetone and isoprene/MBO. Oxygenated VOCs showed also deposition fluxes that were statistically different from zero. Isoprene/methylbutenol and monoterpene fluxes followed well the traditional isoprene algorithm and the hybrid algorithm, respectively. Emission potentials of monoterpenes were largest in late spring and fall which was possibly driven by growth processes and decaying of soil litter, respectively. Conversely, largest emission potentials of isoprene/methylbutenol were found in July. Thus, we concluded that most of the emissions of m/z 69 at the site consisted of isoprene that originated from broadleaved trees. Methanol had deposition fluxes especially before sunrise. This can be connected to water films on surfaces. Based on this assumption, we were able to build an empirical algorithm for bi-directional methanol exchange that described both emission term and deposition term. Methanol emissions were highest in May and June and deposition level increased towards fall, probably as a result of increasing relative humidity levels leading to predominance of deposition.
    No preview · Article · Jun 2015 · Biogeosciences Discussions
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    ABSTRACT: In this study a long-term volatile organic compounds (VOCs) data set, measured at the SMEAR II (Station for measuring Ecosystem–Atmosphere Relations) boreal forest site at Hyytiälä, Finland during the years 2006–2011, was investigated. VOC mixing ratios were measured using proton transfer reaction mass spectrometry. Four-day backward trajectories and the Unmix 6.0 receptor model were used for source area and source composition analysis. Two major forest fire events, one in Eastern Europe and one in Russia, took place during the measurement period. The effect of these fires was clearly visible in the trajectory analysis, lending confidence to the method employed with this data set. Elevated volume mixing ratios (VMRs) of non-biogenic VOCs, e.g. acetonitrile and aromatic VOCs, related to forest fires were observed. Ten major source areas for long-lived VOCs (methanol, acetonitrile, acetaldehyde, acetone, benzene and toluene) were identified at the SMEAR II site. The main source areas for all the targeted VOCs were Western Russia, Northern Poland, Kaliningrad and Baltic countries. Industrial areas in Northern Continental Europe were also found to be source areas for certain VOCs. Both trajectory and receptor analysis showed that air masses from Northern Fennoscandia were less polluted with both the VOCs studied and with other trace gases (CO, SO2 and NOx) than areas of Eastern and Western Continental Europe, Western Russia and Southern Fennoscandia.
    No preview · Article · May 2015 · Atmospheric Chemistry and Physics
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    Full-text · Dataset · May 2015
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    ABSTRACT: Cerebral amyloid-β aggregation is an early pathological event in Alzheimer disease (AD), starting decades before dementia onset. Estimates of the prevalence of amyloid pathology in persons without dementia are needed to understand the development of AD and to design prevention studies. To use individual participant data meta-analysis to estimate the prevalence of amyloid pathology as measured with biomarkers in participants with normal cognition, subjective cognitive impairment (SCI), or mild cognitive impairment (MCI). Relevant biomarker studies identified by searching studies published before April 2015 using the MEDLINE and Web of Science databases and through personal communication with investigators. Studies were included if they provided individual participant data for participants without dementia and used an a priori defined cutoff for amyloid positivity. Individual records were provided for 2914 participants with normal cognition, 697 with SCI, and 3972 with MCI aged 18 to 100 years from 55 studies. Prevalence of amyloid pathology on positron emission tomography or in cerebrospinal fluid according to AD risk factors (age, apolipoprotein E [APOE] genotype, sex, and education) estimated by generalized estimating equations. The prevalence of amyloid pathology increased from age 50 to 90 years from 10% (95% CI, 8%-13%) to 44% (95% CI, 37%-51%) among participants with normal cognition; from 12% (95% CI, 8%-18%) to 43% (95% CI, 32%-55%) among patients with SCI; and from 27% (95% CI, 23%-32%) to 71% (95% CI, 66%-76%) among patients with MCI. APOE-ε4 carriers had 2 to 3 times higher prevalence estimates than noncarriers. The age at which 15% of the participants with normal cognition were amyloid positive was approximately 40 years for APOE ε4ε4 carriers, 50 years for ε2ε4 carriers, 55 years for ε3ε4 carriers, 65 years for ε3ε3 carriers, and 95 years for ε2ε3 carriers. Amyloid positivity was more common in highly educated participants but not associated with sex or biomarker modality. Among persons without dementia, the prevalence of cerebral amyloid pathology as determined by positron emission tomography or cerebrospinal fluid findings was associated with age, APOE genotype, and presence of cognitive impairment. These findings suggest a 20- to 30-year interval between first development of amyloid positivity and onset of dementia.
    Full-text · Article · May 2015 · JAMA The Journal of the American Medical Association
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    ABSTRACT: Importance Amyloid-β positron emission tomography (PET) imaging allows in vivo detection of fibrillar plaques, a core neuropathological feature of Alzheimer disease (AD). Its diagnostic utility is still unclear because amyloid plaques also occur in patients with non–AD dementia.Objective To use individual participant data meta-analysis to estimate the prevalence of amyloid positivity on PET in a wide variety of dementia syndromes.Data Sources The MEDLINE and Web of Science databases were searched from January 2004 to April 2015 for amyloid PET studies.Study Selection Case reports and studies on neurological or psychiatric diseases other than dementia were excluded. Corresponding authors of eligible cohorts were invited to provide individual participant data.Data Extraction and Synthesis Data were provided for 1359 participants with clinically diagnosed AD and 538 participants with non–AD dementia. The reference groups were 1849 healthy control participants (with amyloid PET) and an independent sample of 1369 AD participants (with autopsy data).Main Outcomes and Measures Estimated prevalence of positive amyloid PET scans according to diagnosis, age, and apolipoprotein E (APOE) ε4 status, using the generalized estimating equations method.Results The likelihood of amyloid positivity was associated with age and APOE ε4 status. In AD dementia, the prevalence of amyloid positivity decreased from age 50 to 90 years in APOE ε4 noncarriers (86% [95% CI, 73%-94%] at 50 years to 68% [95% CI, 57%-77%] at 90 years; n = 377) and to a lesser degree in APOE ε4 carriers (97% [95% CI, 92%-99%] at 50 years to 90% [95% CI, 83%-94%] at 90 years; n = 593; P < .01). Similar associations of age and APOE ε4 with amyloid positivity were observed in participants with AD dementia at autopsy. In most non–AD dementias, amyloid positivity increased with both age (from 60 to 80 years) and APOE ε4 carriership (dementia with Lewy bodies: carriers [n = 16], 63% [95% CI, 48%-80%] at 60 years to 83% [95% CI, 67%-92%] at 80 years; noncarriers [n = 18], 29% [95% CI, 15%-50%] at 60 years to 54% [95% CI, 30%-77%] at 80 years; frontotemporal dementia: carriers [n = 48], 19% [95% CI, 12%-28%] at 60 years to 43% [95% CI, 35%-50%] at 80 years; noncarriers [n = 160], 5% [95% CI, 3%-8%] at 60 years to 14% [95% CI, 11%-18%] at 80 years; vascular dementia: carriers [n = 30], 25% [95% CI, 9%-52%] at 60 years to 64% [95% CI, 49%-77%] at 80 years; noncarriers [n = 77], 7% [95% CI, 3%-18%] at 60 years to 29% [95% CI, 17%-43%] at 80 years.Conclusions and Relevance Among participants with dementia, the prevalence of amyloid positivity was associated with clinical diagnosis, age, and APOE genotype. These findings indicate the potential clinical utility of amyloid imaging for differential diagnosis in early-onset dementia and to support the clinical diagnosis of participants with AD dementia and noncarrier APOE ε4 status who are older than 70 years.
    Full-text · Article · May 2015 · JAMA The Journal of the American Medical Association
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    ABSTRACT: Atrophy of the medial temporal lobe (MTL) is the main structural magnetic resonance imaging (MRI) finding in the brain of patients with Alzheimer's disease (AD). However, evaluating the degree of atrophy is still demanding. The visual rating method (VRM) was compared with multi-template tensor-based morphometry (TBM), in terms of its efficacy in diagnosing of mild cognitive impairment (MCI) and AD. Forty-seven patients with MCI, 80 patients with AD and 84 controls were studied. TBM seems to be more sensitive than VRM at the early stage of dementia in the areas of MTL and ventricles. The methods were equally good in distinguishing controls and the MCI group from the AD group. At the frontal areas TBM was better than VRM in all comparisons. A user-friendly VRM is still useful for the clinical evaluation of MCI patients, but multi-template TBM is more sensitive for diagnosing the early stages of dementia. However, TBM is currently too demanding to use for daily clinical work. © The Foundation Acta Radiologica 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    No preview · Article · May 2015 · Acta Radiologica

Publication Stats

18k Citations
2,200.39 Total Impact Points


  • 2004-2015
    • University of Helsinki
      • • Department of Physics
      • • Department of Physical Sciences
      Helsinki, Uusimaa, Finland
  • 1999-2015
    • Turku PET Centre
      Turku, Southwest Finland, Finland
    • Finnish Meteorological Institute
      • Air Quality Research
      Helsinki, Southern Finland Province, Finland
  • 1985-2015
    • University of Turku
      • • Turku PET Centre
      • • Department of Neurology
      • • Division of Psychology
      Turku, Varsinais-Suomi, Finland
  • 1996-2014
    • Turku University Hospital
      • Turku PET Centre
      Turku, Varsinais-Suomi, Finland
  • 2006-2012
    • Åbo Akademi University
      • Department of Psychology and Logopedics
      Turku, Province of Western Finland, Finland
  • 2011
    • Imperial College London
      Londinium, England, United Kingdom
    • Karolinska Institutet
      • Aging Research Center - ARC
      Solna, Stockholm, Sweden
  • 2008
    • University of Oxford
      Oxford, England, United Kingdom
    • University of Oulu
      Uleoborg, Oulu, Finland
    • Kuopio University Hospital
      • Department of Neurosurgery
      Kuopio, Province of Eastern Finland, Finland
  • 2000-2002
    • National Center for Atmospheric Research
      • Division of Atmospheric Chemistry
      Boulder, Colorado, United States
  • 1999-2001
    • Research Institute of the Finnish Economy, Finland, Helsinki
      Helsinki, Uusimaa, Finland
  • 1994
    • University of London
      • The School of Pharmacy
      Londinium, England, United Kingdom
  • 1992
    • University Center Rochester
      • Department of Neurology
      Рочестер, Minnesota, United States