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Introduction: We performed a retrospective cohort study to identify predictors of concurrent asymptomatic brain ischemia in patients with ischemic monocular vision loss.Patients and methods: An inpatient database research of admissions to the Helios University Hospital Wuppertal, Germany between 01/2016 and 12/2020 was conducted. Inclusion criteria were confirmed diagnosis of transient monocular vision loss (MVL), retinal artery occlusion (RAO), and magnetic resonance imaging (MRI) of the brain within 10 days of MVL. Silent brain ischemia (SBI) was defined as diffusion restrictions with corresponding reduced apparent diffusion coefficient in MRI and an absence of neurological deficits besides those complying with MVL in clinical examination. The prevalence and cardiovascular predictors of SBI were analyzed with logistic regression and an artificial neural network.Results: One hundred fourteen out of 475 patients treated with monocular vision loss were included in this study. The mean age was 67.7 ± 13.6 years. 48.2% were male and 47.4% had RAO. MRI scan of the brain was performed after 3.9 ± 2.3 days and detected SBI in 17%. Age ⩾67 years, cardiac etiology of MVL, and cerebral ischemia in medical history were revealed as predictors of SBI in MRI.Conclusions: Patients older than 66 years, with a suspected cardiac embolism as the cause of RAO and previous cerebral ischemia, are more likely to present SBI in cerebral MRI. Therefore, MR imaging, particularly in these patients, can be useful.

White matter hyperintensities (WMHs) are frequently seen on brain magnetic resonance imaging scans of older people. Usually interpreted clinically as a surrogate for cerebral small vessel disease, WMHs are associated with increased likelihood of cognitive impairment and dementia (including Alzheimer's disease [AD]). WMHs are also seen in cognitively healthy people. In this collaboration of academic, clinical, and pharmaceutical industry perspectives, we identify outstanding questions about WMHs and their relation to cognition, dementia, and AD. What molecular and cellular changes underlie WMHs? What are the neuropathological correlates of WMHs? To what extent are demyelination and inflammation present? Is it helpful to subdivide into periventricular and subcortical WMHs? What do WMHs signify in people diagnosed with AD? What are the risk factors for developing WMHs? What preventive and therapeutic strategies target WMHs? Answering these questions will improve prevention and treatment of WMHs and dementia.

Healthy, right-handed volunteers (six male, six female) either saw or imagined the hands of a clock set at a particular time. In both conditions, they then judged whether the angle between the clock hands was greater than or less than 90 degrees. Subjects pressed one of two response keys to indicate their decision, and hand of response (left/right) was counterbalanced within and between subjects. The subjects had significantly longer reaction times and made significantly more errors when the imaginary angles formed by the clock hands were located in left hemispace (e.g. 8:30) than right hemispace (e.g. 4:30). With visible hands, there was no reaction time difference between visual hemifields, although significantly more errors were made when the angle formed by the hands fell within the left visual field. In the perceptual task (visible hands), reaction times and error rates increased monotonically as the distance between the hands approximated more closely to 90°. This psychophysical relationship was not found in the representational task (imaginary hands). Rather, there was a significant positive correlation between reaction times/error rates and the magnitude of the number indicative of the position of the minute hand. The latter finding is consistent with the hypothesis that the lateral asymmetry in the representational task (reaction times and error rates are higher in left hemispace) is due to the time taken to mentally rotate the imaginary minute hand in a clockwise direction. No such operation is required in the perceptual condition where the hands are clearly visible.

Background:Recently, a new resting-state functional magnetic resonance imaging (rs-fMRI) measure to evaluate the concordance between different rs-fMRI metrics has been proposed and has not been investigated in Alzheimer's disease (AD).Methods:3T rs-fMRI data were obtained from healthy young controls (YC, n= 26), healthy senior controls (SC, n= 29), and AD patients (n= 35). The fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), and degree centrality (DC) were analyzed, followed by the calculation of their concordance using Kendall's W for each brain voxel across time. Group differences in the concordance were compared globally, within seven intrinsic brain networks, and on a voxel-by-voxel basis with covariates of age, sex, head motion, and gray matter volume.Results:The global concordance was lowest in AD among the three groups, with similar differences for the single metrics. When comparing AD to SC, reductions of concordance were detected in each of the investigated networks apart from the limbic network. For SC in comparison to YC, lower global concordance without any network-level difference was observed. Voxel-wise analyses revealed lower concordance in the right middle temporal gyrus in AD compared to SC and lower concordance in the left middle frontal gyrus in SC compared to YC. Lower fALFF were observed in the right angular gyrus in AD in comparison to SC, but ReHo and DC showed no group differences.Conclusions:The concordance of resting-state measures differentiates AD from healthy aging and may represent a novel imaging marker in AD.Impact statementThe usefulness of a new resting-state functional magnetic resonance imaging (rs-fMRI) measure to assess the concordance between different rs-fMRI metrics has been demonstrated in mental disorders such as depression and schizophrenia. Our study, to the best of our knowledge, is the first to confirm a decreased concordance in Alzheimer's disease (AD) patients compared to healthy young and senior individuals on global, network, and voxel-wise levels, which moreover seems to be sensitive in differentiating age-related from AD-related functional brain changes. Our findings suggest that the concordance of rs-fMRI metrics may be useful as a candidate biomarker for neurodegenerative disorders such as AD.

Background:Graph-theoretical analyses have been previously used to investigate changes in the functional connectome in patients with Alzheimer's disease (AD). However, these analyses generally assume static organizational principles, thereby neglecting a fundamental reconfiguration of functional connections in the face of neurodegeneration.Methods:Here, we focus on differences in the community structure of the functional connectome in young and old individuals and patients with AD. Patients with AD, moreover, underwent molecular imaging positron emission tomography by using [18F]AV1451 to measure tau burden, a major hallmark of AD.Results:Although the overall organizational principles of the community structure of the human functional connectome were preserved even in advanced healthy aging, they were considerably changed in AD. We discovered that the communities in AD are re-organized, with nodes changing their allegiance to communities, thus resulting in an overall less efficient re-organized community structure. We further discovered that nodes with a tendency to leave the communities displayed a relatively higher tau pathology burden.Discussion:Together, this study suggests that local tau pathology in AD is associated to fundamental changes in basic organizational principles of the human connectome. Our results shed new light on previous findings obtained by using the graph theory in AD and imply a general principle of the brain in response to neurodegeneration.