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2019 Fiscal Year Research-status Report

頚動脈内膜剥離術を用いた脳循環不全性認知症とアルツハイマー病の関連の解明

Research Project

Project/Area Number 18K09002
Research InstitutionIwate Medical University

Principal Investigator

小笠原 邦昭  岩手医科大学, 医学部, 教授 (00305989)

Project Period (FY) 2018-04-01 – 2021-03-31
Keywordsアルツハイマー病 / アミロイド / 頚動脈内膜剥離術 / 認知機能 / 脳循環代謝
Outline of Annual Research Achievements

CEAを行う症例を対象とした。全例に術前に脳血流SPECTを行い、脳循環不全をもつ症例を選択した。これらの症例に対し、術前に15O-gas PETおよび脳アミロイド沈着を画像化できる18F-Florbetapir PETを行った。また、7T超高磁場MRIにより拡散尖度(diffusion kurtosis)画像を撮像した。さらに、神経心理検査として、Wechsler adult intelligence scale-revised (WAIS-R)、Wechsler memory scale-revised (WMS-R)、Rey testを行った。15O-gas PETおよび18F-Florbetapir PET画像の解析はSPM2を基本とした画像標準化テンプレートである3D-SRTを用い、前者は定量解析を、後者は小脳を対照とした半定量的解析を行った。拡散尖度画像はtract-based spatial statistics (TBSS)にて白質の解剖学的微細構造を定量的に解析した。
5例に対し頚動脈内膜剥離術前後にアミロイドPETおよび15OガスPETを行った。その結果以下の結論を得た。1.脳循環代謝が低下している脳領域では、アミロイドPET上トレーサが入っていかないことがある。2.脳循環代謝の低下は必ずしもアミロイドの沈着をもたらさない.3.頚動脈内膜剥離術後にPET上脳循環が改善するとアミロイドPET上アミロイドが明らかにwash outされる。以上から以下の結論を得た。1.脳循環代謝が低下している脳領域では、アミロイドPET上、アミロイドの沈着が過小評価されることがある。2.脳血管障害による脳循環不全が脳からのアミロイドの排出を阻害するかどうかは結論をだせない。3.2.にもかかわらず、脳循環の改善が脳からのアミロイドの排出を促す。

Current Status of Research Progress
Current Status of Research Progress

1: Research has progressed more than it was originally planned.

Reason

1.脳循環代謝が低下している脳領域では、アミロイドPET上、アミロイドの沈着が過小評価されることがある。
2.脳血管障害による脳循環不全が脳からのアミロイドの排出を阻害するかどうかは結論をだせない。
3.2.にもかかわらず、脳循環の改善が脳からのアミロイドの排出を促す。
の3つの結論を以下のように英文論文化し公表した。
1. Decrease in 18F-Florbetapir Accumulation in the Cerebral Hemisphere With Hypoperfusion and Misery Perfusion Due to Chronic Atherosclerotic Occlusion of the Internal Carotid Artery. Takahashi T, Kobayashi M, Fujiwara S, Kubo Y, Terasaki K, Ogasawara K. Clin Nucl Med. 2020 Feb;45(2):e115-e116.
2. Reduction in amyloid β deposition on (18)F-florbetapir positron emission tomography with correction of cerebral hypoperfusion after endarterectomy for carotid stenosis. Ogasawara K, Fujiwara S, Chida K, Terasaki K, Sasaki M, Kubo Y. Am J Nucl Med Mol Imaging. 2019 Dec 15;9(6):316-320.

Strategy for Future Research Activity

今後は認知機能とアミロイドのwash outとの関係を検討し、最終目標である「頚動脈狭窄を除去することによる脳循環不全の改善により、アミロイドの排出が促され、可逆的な脳白質障害が改善し、認知機能が改善する」ことがヒトでも成り立つかどうかを明らかにする予定である。

Causes of Carryover

病院移転があり、移転後数カ月見込んでいた検査ができなかったため。

  • Research Products

    (14 results)

All 2020 2019

All Journal Article (8 results) (of which Peer Reviewed: 8 results,  Open Access: 2 results) Presentation (6 results) (of which Int'l Joint Research: 6 results)

  • [Journal Article] Acetazolamide-Loaded Dynamic 7T MR Quantitative Susceptibility Mapping in Major Cerebral Artery Steno-Occlusive Disease: Comparison with PET.2020

    • Author(s)
      Fujimoto K, Uwano I, Sasaki M, Oshida S, Tsutsui S, Yanagihara W, Fujiwara S, Kobayashi M, Kubo Y, Yoshida K, Terasaki K, Ogasawara K
    • Journal Title

      AJNR Am J Neuroradiol

      Volume: in press Pages: in press

    • DOI

      10.3174/ajnr.A6508

    • Peer Reviewed
  • [Journal Article] Identification of the Distal End of Carotid Plaque Using 3-Dimensional Fast Spin Echo T1-Weighted Magnetic Resonance Plaque Imaging.2020

    • Author(s)
      Chida K, Shimada Y, Fujimoto K, Yoshida J, Kojima D, Fujiwara S, Kobayashi M, Yoshida K, Sasaki M, Ogasawara K.
    • Journal Title

      J Stroke Cerebrovasc Dis

      Volume: in press Pages: in press

    • DOI

      10.1016/j.jstrokecerebrovasdis.2020.104680

    • Peer Reviewed
  • [Journal Article] Revascularisation surgery improves cognition in adult patients with moyamoya disease.2020

    • Author(s)
      Ando T, Shimada Y, Fujiwara S, Yoshida K, Kobayashi M, Kubo Y, Terasaki K, Ando S, Ogasawara K.
    • Journal Title

      J Neurol Neurosurg Psychiatry

      Volume: 91 Pages: 332-334

    • DOI

      10.1136/jnnp-2019-321069

    • Peer Reviewed
  • [Journal Article] Decrease in 18F-Florbetapir Accumulation in the Cerebral Hemisphere With Hypoperfusion and Misery Perfusion Due to Chronic Atherosclerotic Occlusion of the Internal Carotid Artery.2020

    • Author(s)
      Takahashi T, Kobayashi M, Fujiwara S, Kubo Y, Terasaki K, Ogasawara K.
    • Journal Title

      Clin Nucl Med

      Volume: 45 Pages: e115-e116

    • DOI

      10.1097/RLU.0000000000002774

    • Peer Reviewed
  • [Journal Article] Adverse effects of pre-existing cerebral small vessel disease on cognitive improvement after carotid endarterectomy.2020

    • Author(s)
      Yoshida J, Yamashita F, Sasaki M, Yoshioka K, Fujiwara S, Kobayashi M, Yoshida K, Kubo Y, Ogasawara K
    • Journal Title

      Int J Stroke

      Volume: in press Pages: in press

    • DOI

      10.1177/1747493019874732

    • Peer Reviewed
  • [Journal Article] Reduction in amyloid β deposition on 18F-florbetapir positron emission tomography with correction of cerebral hypoperfusion after endarterectomy for carotid stenosis.2019

    • Author(s)
      Ogasawara K, Fujiwara S, Chida K, Terasaki K, Sasaki M, Kubo Y.
    • Journal Title

      Am J Nucl Med Mol Imaging.

      Volume: 9 Pages: 316-320

    • Peer Reviewed / Open Access
  • [Journal Article] Reduced Hypoxic Tissue and Cognitive Improvement after Revascularization Surgery for Chronic Cerebral Ischemia.2019

    • Author(s)
      Shimada Y, Kobayashi M, Yoshida K, Terasaki K, Fujiwara S, Kubo Y, Beppu T, Ogasawara K.
    • Journal Title

      Cerebrovasc Dis

      Volume: 47 Pages: 57-64

    • DOI

      10.1159/000497244

    • Peer Reviewed / Open Access
  • [Journal Article] Cilostazol may improve cognition better than clopidogrel in non-surgical adult patients with ischemic moyamoya disease: subanalysis of a prospective cohort.2019

    • Author(s)
      Ando S, Tsutsui S, Miyoshi K, Sato S, Yanagihara W, Setta K, Chiba T, Fujiwara S, Kobayashi M, Yoshida K, Kubo Y, Ogasawara K.
    • Journal Title

      Neurol Res

      Volume: 41 Pages: 480-487

    • DOI

      10.1080/01616412.2019.1580455

    • Peer Reviewed
  • [Presentation] Relation between reduction of hypoxic tissue and cognitive improvement after revascularization surgery in patients with chronic cerebral ischemia.2019

    • Author(s)
      Shimada Y., Kobayashi1 M., Yoshida K., Terasaki K., Fujiwara S., Kubo Y,, Beppu T., Ogasawara K
    • Organizer
      5th European Stroke Organization Conference (ESOC 2019)
    • Int'l Joint Research
  • [Presentation] Cerebral hyperperfusion-related inhibit of development of cerebral ischemic lesions after revascularization due to artery-to-artery emboli during carotid exposure in endarterectomy for patients chronic ischemia.2019

    • Author(s)
      Fujimoto K., Matsumoto Y., Oikawa K., Nomura J., Shimada Y., Fujiwara S., Terasaki K., Kobayashi M., Yoshida K., Ogasawara K
    • Organizer
      5th European Stroke Organization Conference (ESOC 2019)
    • Int'l Joint Research
  • [Presentation] Cerebral white matter abnormalities can affect cognitive improvement after carotid endarterectomy in patients with carotid artery steno-occlusive disease.2019

    • Author(s)
      Yoshida J., Yamashita F., SasakiM., Yoshioka Y., Fujiwara S., Kobayashi M., Yoshida K., Kubo Y., Ogasawara K.
    • Organizer
      Computer Assisted Radiology and Surgery(CARS)2019
    • Int'l Joint Research
  • [Presentation] Feasibility of apparent brain temperature map by 1H-MRS to detect hemodynamic abnormality in patients with unilateral chronic major cerebral artery steno-occlusive disease.2019

    • Author(s)
      Namba T., Ogasawara K., *Yoshioka Y., Sasaki M., Uwano I., Ishigaki D., Kobayashi M., Yoshida K., Fujiwara S., Terasaki K.
    • Organizer
      BRAIN & BRAIN PET 2019
    • Int'l Joint Research
  • [Presentation] Crossed cerebellar tracer uptake on acute-stage 123I-iomazenil SPECT imagingpredicts 3-month functional outcome in patients with non-fatal hypertensive putaminal or thalamic hemorrhage.2019

    • Author(s)
      Kojima D., Komoribayashi N., Omama S., Oikawa K., Fujiwara S., Kobayashi M., Kubo Y., Terasaki K., Ogasawara K.
    • Organizer
      BRAIN & BRAIN PET 2019
    • Int'l Joint Research
  • [Presentation] Reduced hypoxic tissue and cognitive improvement after revascularization surgery for chronic cerebral ischemia.2019

    • Author(s)
      Shimada Y., Kobayashi M., Yoshida K., Terasaki K., Fujiwara S., Kubo Y., Beppu T., Ogasawara K.
    • Organizer
      BRAIN & BRAIN PET 2019
    • Int'l Joint Research

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Published: 2021-01-27  

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