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Cerebrovascular hemodynamics association with brain structure and function in Multiple Sclerosis
Cristina Duque1, Simin Mahinrad2, Sanaz Sedaghat3
1Department of Neurology, Hospital Pedro Hispano, Matosinhos, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal; Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, USA.
Insights
Efficient cerebral autoregulation in Multiple Sclerosis (MS) is linked to better brain structure and cognitive function. This study explored cerebrovascular hemodynamics (CVH) and its relation to MS progression.
Area of Science:
- Neuroscience
- Vascular Biology
- Medical Imaging
Background:
- Vascular risk factors may influence Multiple Sclerosis (MS) progression, but the underlying mechanisms remain unclear.
- Understanding cerebrovascular hemodynamics (CVH) in MS is crucial for elucidating the link between vascular health and MS.
- Cerebrovascular hemodynamics encompass dynamic cerebral autoregulation (dCA) and vasoreactivity (VR).
Purpose of the Study:
- To investigate the relationship between CVH (dCA and VR) and brain structure (MRI) and function (cognition, gait) in individuals with MS.
- To assess how dynamic cerebral autoregulation and vasoreactivity correlate with gray matter volume, white matter hyperintensities, and cognitive performance.
- To determine if CVH markers are associated with gait function in MS patients.
Main Methods:
- Utilized Transcranial Doppler ultrasound (TCD) to measure dCA (phase and gain) and VR.
- Calculated dCA from spontaneous blood pressure and flow velocity oscillations.
- Quantified brain structure using MRI (GM, WM, WMH volumes, WM lesion counts) and assessed cognitive and gait function.
Main Results:
- Higher phase values (indicating better dCA) correlated with greater gray matter volume and reduced white matter hyperintensity burden.
- Improved dCA was associated with higher scores in memory and global cognitive domains.
- No significant relationship was found between CVH markers (dCA or VR) and gait speed, nor between VR and brain structure or function.
Conclusions:
- Enhanced dynamic cerebral autoregulation is associated with better brain structure, specifically larger gray matter volumes and lower white matter hyperintensity burden in MS patients.
- More efficient cerebral autoregulation is linked to improved cognitive function in individuals with MS.
- Cerebral autoregulation does not appear to influence gait function in this MS cohort.
Background:
Vascular risk factors seem to contribute to disease progression in Multiple Sclerosis (MS), but the mechanistic connection between vascular risk and MS is unknown. Understanding cerebrovascular hemodynamics (CVH) in MS may help advance our understanding of the link between vascular risk and MS.
Objectives:
Examine the relationship between CVH [dynamic cerebral autoregulation (dCA) and vasoreactivity (VR)] and brain structure (MRI) and function (cognition, and gait) in individuals with MS.
Methods:
Transcranial Doppler ultrasound (TCD) was utilized to assess two key markers of CVH: dCA and VR. dCA (reported as phase and gain) is calculated from the spontaneous blood pressure and flow velocity oscillations. VR is calculated as the slope of change in cerebral blood flow velocity in response to end-tidal CO2. Global gray matter (GM), white matter (WM), WM hyperintensity (WMH) volumes and WM lesion counts were measured from brain MRI. All participants underwent detailed cognitive and gait assessments.
Results:
Eighty participants were included (age 44 ± 11, 26 % male); 75 had relapsing-remitting MS (94 %), with disease duration of 8 (11) years [median (IQR)] since MS diagnosis and an Expanded Disability Status Scale (EDSS) of 2.0 (4.0). Higher phase (better dCA) was associated with greater GM volume, lower WHM burden and higher cognitive scores in the memory and global cognitive domains (all P values <0.05). There was no relationship between CVH and gait speed in our study participants. There was no relationship between VR and any measures of brain structure and function.
Conclusions:
More efficient cerebral autoregulation is associated with better brain structure (larger GM and lower WMH volumes) and function (cognition, but not gait) in patients with MS.
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