Jugular Venous Reflux and White Matter Abnormalities in Alzheimer's Disease: A Pilot Study

Article type: Research Article

Authors: Chung, Chih-Ping^{a; b} | Beggs, Clive^c | Wang, Pei-Ning^{a; b; 1} | Bergsland, Niels^d | Shepherd, Simon^c | Cheng, Chun-Yu^{a; b; e} | Ramasamy, Deepa P.^d | Dwyer, Michael G.^d | Hu, Han-Hwa^{a; b} | Zivadinov, Robert^{d; *; 1}

Affiliations: [a] Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan | [b] Department of Neurology, National Yang Ming University of Medicine, Taipei, Taiwan | [c] Centre for Infection Control and Biophysics, University of Bradford, Bradford, UK | [d] Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo, Buffalo, NY, USA | [e] Institute of Brain Science, National Yang-Ming University School of Medicine, Taipei, Taiwan

Correspondence: [*] Correspondence to: Dr. Robert Zivadinov, Professor of Neurology, School of Medicine and Biomedical Sciences, State University of New York, Director, Buffalo Neuroimaging Analysis Center, 100 High Street, Buffalo, NY 14203, USA. E-mail: rzivadinov@bnac.net.

Note: [1] These authors contributed equally to this manuscript.

Abstract: To determine whether jugular venous reflux (JVR) is associated with cerebral white matter changes (WMCs) in individuals with Alzheimer's disease (AD), we studied 12 AD patients 24 mild cognitive impairment (MCI) patients, and 17 elderly age- and gender-matched controls. Duplex ultrasonography and 1.5T MRI scanning was applied to quantify cerebral WMCs [T2 white matter (WM) lesion and dirty-appearing-white-matter (DAWM)]. Subjects with severe JVR had more frequently hypertension (p = 0.044), more severe WMC, including increased total (p = 0.047) and periventricular DAWM volumes (p = 0.008), and a trend for increased cerebrospinal fluid volumes (p = 0.067) compared with the other groups. A significantly decreased (65.8%) periventricular DAWM volume (p = 0.01) in the JVR-positive AD individuals compared with their JVR-negative counterparts was detected. There was a trend for increased periventricular and subcortical T2 WMC lesion volumes in the JVR-positive AD individuals compared with their JVR-negative counterparts (p = 0.073). This phenomenon was not observed in either the control or MCI groups. In multiple regression analysis, the increased periventricular WMC lesion volume and decreased DAWM volume resulted in 85.7% sensitivity and 80% specificity for distinguishing between JVR-positive and JVR-negative AD patients. These JVR-WMC association patterns were not seen in the control and MCI groups. Therefore, this pilot study suggests that there may be an association between JVR and WMCs in AD patients, implying that cerebral venous outflow impairment might play a role in the dynamics of WMCs formation in AD patients, particularly in the periventricular regions. Further longitudinal studies are needed to confirm and validate our findings.

Keywords: Alzheimer's disease, Doppler ultrasonography, jugular veins, leukoaraiosis, magnetic resonance imaging

DOI: 10.3233/JAD-131112

Journal: Journal of Alzheimer's Disease, vol. 39, no. 3, pp. 601-609, 2014