Magnetic resonance imaging for assessment of cerebrovascular reactivity and its relationship to cognition: a systematic review

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Abstract

Background

Cerebrovascular reactivity (CVR) refers to the responsiveness of cerebral vasculature to vasoactive stimuli. CVR is an indicator of brain health and can be assessed using vasodilatory techniques and magnetic resonance imaging (MRI). Using such approaches, some researchers have explored the relationship between CVR and cognition; here we systematically review this work.

Results

We extracted information pertaining to: (1) study location and design, participant characteristics, sample sizes, (2) design of vascular challenge, end-tidal CO ₂ (etCO ₂) concentrations (if applicable), (3) MRI protocol, (4) cognitive assessment, (5) CVR values, and outcomes of statistical analyses with cognitive tests. Five studies assessed participants with cognitive impairment compared to controls, one studied patients with multiple sclerosis with or without cognitive impairment compared to controls, one examined patients with moyamoya disease with or without cognitive impairment, two investigated patients with Type 2 diabetes mellitus (T2DM), and one was a cross-sectional study with younger and older healthy adults. Cognition was typically probed using the MMSE and tests of executive function, while a number of vasodilatory techniques were employed.

Conclusion

CVR was associated with cognition in six of ten studies, but heterogeneity of study samples, designs and vasodilatory methods may have a role in the inconsistent findings. We make recommendations for future research that includes use of a multi-domain cognitive assessment and standardised hypercapnic challenge with MRI.

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Cardiovascular Risk Factors Promote Brain Hypoperfusion Leading to Cognitive Decline and Dementia

Jack C de la Torre (2012)

Heart disease is the major leading cause of death and disability in the world. Mainly affecting the elderly population, heart disease and its main outcome, cardiovascular disease, have become an important risk factor in the development of cognitive decline and Alzheimer's disease (AD). This paper examines the evidence linking chronic brain hypoperfusion induced by a variety of cardiovascular deficits in the development of cognitive impairment preceding AD. The evidence indicates a strong association between AD and cardiovascular risk factors, including ApoE4, atrial fibrillation, thrombotic events, hypertension, hypotension, heart failure, high serum markers of inflammation, coronary artery disease, low cardiac index, and valvular pathology. In elderly people whose cerebral perfusion is already diminished by their advanced age, additional reduction of cerebral blood flow stemming from abnormalities in the heart-brain vascular loop ostensibly increases the probability of developing AD. Evidence also suggests that a neuronal energy crisis brought on by relentless brain hypoperfusion may be responsible for protein synthesis abnormalities that later result in the classic neurodegenerative lesions involving the formation of amyloid-beta plaques and neurofibrillary tangles. Insight into how cardiovascular risk factors can induce progressive cognitive impairment offers an enhanced understanding of the multifactorial pathophysiology characterizing AD and ways at preventing or managing the cardiovascular precursors of this dementia.

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The cognitive correlates of white matter abnormalities in normal aging: a quantitative review.

Faith M Gunning-Dixon, Naftali Raz (2000)

Cerebral white matter of asymptomatic people frequently exhibits circumscribed areas of hyperintensity on magnetic resonance (MR) images and hypodensity on computed tomography scans. However, behavioral implications of this phenomenon remain unclear. In this meta-analysis, the authors examine cumulative evidence regarding the cognitive sequelae of white matter abnormalities in adults without dementia. The influence of potential moderator variables, such as neuroimaging technique, location of the lesions, rating scale, and demographic characteristics of the sample on the association between the burden of white matter hyperintensities and cognitive performance was also examined. Results indicate that white matter abnormalities observed on MR images are associated with attenuated performance on tasks of processing speed, immediate and delayed memory, executive functions, and indices of global cognitive functioning. There was no significant link between the white matter hyperintensities and psychometric indices of intelligence or fine motor performance.

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Measuring cerebrovascular reactivity: what stimulus to use?

R A Battisti, J Duffin, J Fierstra … (2013)

Cerebrovascular reactivity is the change in cerebral blood flow in response to a vasodilatory or vasoconstrictive stimulus. Measuring variations of cerebrovascular reactivity between different regions of the brain has the potential to not only advance understanding of how the cerebral vasculature controls the distribution of blood flow but also to detect cerebrovascular pathophysiology. While there are standardized and repeatable methods for estimating the changes in cerebral blood flow in response to a vasoactive stimulus, the same cannot be said for the stimulus itself. Indeed, the wide variety of vasoactive challenges currently employed in these studies impedes comparisons between them. This review therefore critically examines the vasoactive stimuli in current use for their ability to provide a standard repeatable challenge and for the practicality of their implementation. Such challenges include induced reductions in systemic blood pressure, and the administration of vasoactive substances such as acetazolamide and carbon dioxide. We conclude that many of the stimuli in current use do not provide a standard stimulus comparable between individuals and in the same individual over time. We suggest that carbon dioxide is the most suitable vasoactive stimulus. We describe recently developed computer-controlled MRI compatible gas delivery systems which are capable of administering reliable and repeatable vasoactive CO2 stimuli.

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Author and article information

Contributors

Sarah J. Catchlove:

ORCID: http://orcid.org/0000-0003-2314-1706

scatchlove@swin.edu.au

Andrew Pipingas: apipingas@swin.edu.au

Matthew E. Hughes: matthewhughes@swin.edu.au

Helen Macpherson: helen.macpherson@deakin.edu.au

Journal

Journal ID (nlm-ta): BMC Neurosci

Journal ID (iso-abbrev): BMC Neurosci

Title: BMC Neuroscience

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2202

Publication date (Electronic): 12 April 2018

Publication date PMC-release: 12 April 2018

Publication date Collection: 2018

Volume: 19

Electronic Location Identifier: 21

Affiliations

[1 ]ISNI 0000 0004 0409 2862, GRID grid.1027.4, Centre for Human Psychopharmacology, , Swinburne University, ; Hawthorn, Australia

[2 ]ISNI 0000 0004 0409 2862, GRID grid.1027.4, Centre for Mental Health, , Swinburne University, ; Hawthorn, Australia

[3 ]Australian National Imaging Facility, St. Lucia, Australia

[4 ]ISNI 0000 0001 0526 7079, GRID grid.1021.2, Institute for Physical Activity and Nutrition, , Deakin University, ; Geelong, Australia

Author information

Sarah J. Catchlove http://orcid.org/0000-0003-2314-1706

Article

Publisher ID: 421

DOI: 10.1186/s12868-018-0421-4

PMC ID: 5898077

PubMed ID: 29649969

SO-VID: 1619d4b7-a9e2-4efc-8ef5-223532733efb

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 11 January 2018

Date accepted : 27 March 2018

Funding

Funded by: Barbara Dicker Brain Sciences Foundation

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ScienceOpen disciplines: Neurosciences

Keywords: cognition,cerebrovascular reactivity,vasodilation,magnetic resonance imaging (mri),brain

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ScienceOpen disciplines: Neurosciences

Keywords: cognition, cerebrovascular reactivity, vasodilation, magnetic resonance imaging (mri), brain

Magnetic resonance imaging for assessment of cerebrovascular reactivity and its relationship to cognition: a systematic review

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Most cited references 48

Cardiovascular Risk Factors Promote Brain Hypoperfusion Leading to Cognitive Decline and Dementia

The cognitive correlates of white matter abnormalities in normal aging: a quantitative review.

Measuring cerebrovascular reactivity: what stimulus to use?

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