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      An investigation of changes in regional gray matter volume in cardiovascular disease patients, pre and post cardiovascular rehabilitation ☆

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          Abstract

          Cognitive function decline secondary to cardiovascular disease has been reported. However, little is known about the impact of coronary artery disease (CAD) on the aging brain macrostructure or whether exercise training, in the context of cardiovascular rehabilitation, can affect brain structure following a coronary event. This study employed voxel-based morphometry of high resolution structural MRI images to investigate; 1) changes in regional gray matter volume (GMV) in CAD patients compared to age-matched controls, and 2) the effects of a six-month exercise-based cardiovascular rehabilitation program on CAD-related GMV decline. Compared to controls, significant decreases in regional GMV were found in the superior, medial and inferior frontal gyrus; superior and inferior parietal gyrus; middle and superior temporal gyrus and in the posterior cerebellum of CAD patients. Cardiovascular rehabilitation was associated with the recovery of regional GMV in the superior frontal gyrus, superior temporal gyrus and posterior cerebellum of the CAD patients as well as the increase in GMV in the supplementary motor area. Total and regional GMV correlated with fitness level, defined by the maximal oxygen consumption (VO 2max), at baseline but not after cardiovascular rehabilitation. This study demonstrates that cardiovascular disease can adversely affect age-related decline in GMV; and that these disease-related effects could be mitigated by moderate levels of exercise training as part of cardiovascular rehabilitation.

          Highlights

          • •

            We examined GMV loss with VBM in patients recently diagnosed with CAD.

          • •

            VBM revealed widespread GMV loss in cognitive regions in patients and not controls.

          • •

            An apparent recovery of volume was observed in few affected regions post CR.

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          Most cited references30

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          Cardiovascular fitness, cortical plasticity, and aging.

          Stanley J. Colcombe, Arthur Kramer, Kirk I Erickson … (2004)
          Cardiovascular fitness is thought to offset declines in cognitive performance, but little is known about the cortical mechanisms that underlie these changes in humans. Research using animal models shows that aerobic training increases cortical capillary supplies, the number of synaptic connections, and the development of new neurons. The end result is a brain that is more efficient, plastic, and adaptive, which translates into better performance in aging animals. Here, in two separate experiments, we demonstrate for the first time to our knowledge, in humans that increases in cardiovascular fitness results in increased functioning of key aspects of the attentional network of the brain during a cognitively challenging task. Specifically, highly fit (Study 1) or aerobically trained (Study 2) persons show greater task-related activity in regions of the prefrontal and parietal cortices that are involved in spatial selection and inhibitory functioning, when compared with low-fit (Study 1) or nonaerobic control (Study 2) participants. Additionally, in both studies there exist groupwise differences in activation of the anterior cingulate cortex, which is thought to monitor for conflict in the attentional system, and signal the need for adaptation in the attentional network. These data suggest that increased cardiovascular fitness can affect improvements in the plasticity of the aging human brain, and may serve to reduce both biological and cognitive senescence in humans.
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            The effects of training on heart rate; a longitudinal study.

            M Karvonen, E Kentala, O MUSTALA (1957)
            Article 0 comments Cited 288 times – based on 0 reviews     Review now
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              A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults.

              Patrick D. Barnes, Kristine Yaffe, William Satariano … (2003)
              To determine whether cardiorespiratory fitness at baseline is associated with maintenance of cognitive function over 6 years or with level of cognitive function on tests performed 6 years later in a longitudinal study of healthy older people. Prospective cohort. Community-based study of noninstitutionalized adults aged 55 and older living in Sonoma, California. Three hundred forty-nine cohort members without evidence of cardiovascular disease, musculoskeletal disability, or cognitive impairment at baseline. Cardiorespiratory fitness measures were based on a standard treadmill exercise test protocol and included peak oxygen consumption (peak VO2), treadmill exercise duration, and oxygen uptake efficiency slope (OUES). Cognitive function was evaluated at baseline with a modified Mini-Mental State Examination (mMMSE) and after 6 years of follow-up with a detailed cognitive test battery that included the full MMSE, three tests of attention/executive function, two measures of verbal memory, and two tests of verbal fluency. Participants with worse cardiorespiratory fitness at baseline experienced greater decline on the mMMSE over 6 years (mean mMMSE decline (95% confidence interval) by baseline peak VO2 tertile: lowest = -0.5 (-0.8 to -0.3), middle = -0.2 (-0.5-0.0), highest = 0.0 (-0.3-0.2), P =.002 for trend over tertiles). Participants with worse baseline cardiorespiratory fitness also performed worse on all cognitive tests conducted 6 years later. Results were similar for analyses based on peak VO2, treadmill exercise duration, and OUES. After adjustment for demographic and health-related covariates, measures of cardiorespiratory fitness were associated most strongly with measures of global cognitive function and attention/executive function. Baseline measures of cardiorespiratory fitness are positively associated with preservation of cognitive function over a 6-year period and with levels of performance on cognitive tests conducted 6 years later in healthy older adults. High cardiorespiratory fitness may protect against cognitive dysfunction in older people.
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                Author and article information

                Contributors
                U.C. Anazodo
                Journal
                Journal ID (nlm-ta): Neuroimage Clin
                Journal ID (iso-abbrev): Neuroimage Clin
                Title: NeuroImage : Clinical
                Publisher: Elsevier
                ISSN (Electronic): 2213-1582
                Publication date PMC-release: 6 October 2013
                Publication date (Electronic): 6 October 2013
                Publication date Collection: 2013
                Volume: 3
                Pages: 388-395
                Affiliations
                [a ]Lawson Health Research Institute, London, ON, Canada
                [b ]Department of Medical Biophysics, Western University, London, ON, Canada
                [c ]Laboratory for Brain and Heart Health, School of Kinesiology, Western University, London, ON, Canada
                [d ]Cardiac Rehabilitation Program, Division of Cardiology, Western University, London, ON, Canada
                Author notes
                [* ]Corresponding author at: Lawson Health Research Institute, 268 Grosvenor Street, London, ON N6A4V2, Canada. Tel.: + 1 519 646 6100x65732; fax: + 1 519 646 6205. uanazodo@ 123456lawsonimaging.ca
                Article
                Publisher ID: S2213-1582(13)00128-9
                DOI: 10.1016/j.nicl.2013.09.011
                PMC ID: 3814972
                PubMed ID: 24273722
                SO-VID: d723e632-e7e5-471d-82f1-76944cd5252a
                Copyright © © 2013 The Authors
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivative Works License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 28 June 2013
                Date revision received : 14 September 2013
                Date accepted : 29 September 2013
                Categories
                Subject: Article

                Keywords: cad, coronary artery disease,cr, cardiovascular rehabilitation,gmv, gray matter volume,mets, metabolic equivalents,moca, montreal cognitive assessment,vbm, voxel-based morphometry,vo2max, maximal oxygen consumption,coronary artery disease,exercise training,neuroplasticity,regional brain atrophy,voxel-based morphometry
                Data availability:
                Keywords: cad, coronary artery disease, cr, cardiovascular rehabilitation, gmv, gray matter volume, mets, metabolic equivalents, moca, montreal cognitive assessment, vbm, voxel-based morphometry, vo2max, maximal oxygen consumption, coronary artery disease, exercise training, neuroplasticity, regional brain atrophy, voxel-based morphometry

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