Study design A reliability study was conducted Objectives To develop a classification system for lumbar disc degeneration based on routine magnetic resonance imaging, to investigate the applicability of a simple algorithm, and to assess the reliability of this classification system Summary of background data A standardized nomenclature in the assessment of disc abnormalities is a prerequisite for a comparison of data from different investigations The reliability of the assessment has a crucial influence on the validity of the data Grading systems of disc degeneration based on state of the art magnetic resonance imaging and corresponding reproducibility studies currently are sparse Methods A grading system for lumbar disc degeneration was developed on the basis of the literature An algorithm to assess the grading was developed and optimized by reviewing lumbar magnetic resonance examinations The reliability of the algorithm in depicting intervertebral disc alterations was tested on the magnetic resonance images of 300 lumbar intervertebral discs in 60 patients (33 men and 27 women) with a mean age of 40 years (range, 10-83 years) All scans were analyzed independently by three observers Intra- and interobserver reliabilities were assessed by calculating kappa statistics Results There were 14 Grade I, 82 Grade II, 72 Grade III, 68 Grade IV, and 64 Grade V discs The kappa coefficients for intra- and interobserver agreement were substantial to excellent: intraobserver (kappa range, 084-090) and interobserver (kappa range, 069-081) Complete agreement was obtained, on the average, in 838% of all the discs A difference of one grade occurred in 159% and a difference of two or more grades in 13% of all the cases Conclusion Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation

Magnetic resonance classification of lumbar intervertebral disc degeneration.

European Resuscitation Council Guidelines for Resuscitation.

Objectives To review the evidence for an association of white matter hyperintensities with risk of stroke, cognitive decline, dementia, and death.

Design Systematic review and meta-analysis.

Data sources PubMed from 1966 to 23 November 2009.

Study selection Prospective longitudinal studies that used magnetic resonance imaging and assessed the impact of white matter hyperintensities on risk of incident stroke, cognitive decline, dementia, and death, and, for the meta-analysis, studies that provided risk estimates for a categorical measure of white matter hyperintensities, assessing the impact of these lesions on risk of stroke, dementia, and death.

Data extraction Population studied, duration of follow-up, method used to measure white matter hyperintensities, definition of the outcome, and measure of the association of white matter hyperintensities with the outcome.

Data synthesis 46 longitudinal studies evaluated the association of white matter hyperintensities with risk of stroke (n=12), cognitive decline (n=19), dementia (n=17), and death (n=10). 22 studies could be included in a meta-analysis (nine of stroke, nine of dementia, eight of death). White matter hyperintensities were associated with an increased risk of stroke (hazard ratio 3.3, 95% confidence interval 2.6 to 4.4), dementia (1.9, 1.3 to 2.8), and death (2.0, 1.6 to 2.7). An association of white matter hyperintensities with a faster decline in global cognitive performance, executive function, and processing speed was also suggested.

Conclusion White matter hyperintensities predict an increased risk of stroke, dementia, and death. Therefore white matter hyperintensities indicate an increased risk of cerebrovascular events when identified as part of diagnostic investigations, and support their use as an intermediate marker in a research setting. Their discovery should prompt detailed screening for risk factors of stroke and dementia.

https://www.bmj.com/content/bmj/341/bmj.c3666.full.pdf

The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis

Non-specific low back pain

We propose that cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes. The "vascular depression" hypothesis is supported by the comorbidity of depression, vascular disease, and vascular risk factors and the association of ischemic lesions to distinctive behavioral symptoms. Disruption of prefrontal systems or their modulating pathways by single lesions or by an accumulation of lesions exceeding a threshold are hypothesized to be central mechanisms in vascular depression. The vascular depression concept can generate studies of clinical and heuristic value. Drugs used for the prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes. The choice of antidepressants in vascular depression may depend on their effect on neurologic recovery from ischemic lesions. Research can clarify the pathways to vascular depression by focusing on the site of the lesion, the resultant brain dysfunction, the presentation of depression and time of onset, and the contribution of nonbiological factors.

'Vascular depression' hypothesis.

STUDY DESIGN: Cross-sectional magnetic resonance imaging (MRI) study. OBJECTIVES: To study the relation of low back pain (LBP) to disc degeneration in the lumbar spine. BACKGROUND DATA: Controversy still prevails about the relationship between disc degeneration and LBP. Classification of disc degeneration and symptoms varies, hampering comparison of study results. METHODS: Subjects comprised 164 men aged 40-45 years-53 machine drivers, 51 construction carpenters, and 60 office workers. The data of different types of LBP, individual characteristics, and lifestyle factors were obtained from a questionnaire and a structured interview. Degeneration of discs L2/L3-L5/S1 (dark nucleus pulposus and posterior and anterior bulge) was assessed with MRI. RESULTS: An increased risk of LBP (including all types) was found in relation to all signs of disc degeneration. An increased risk of sciatic pain was found in relation to posterior bulges, but local LBP was not related to disc degeneration. The risks of LBP and sciatic pain were strongly affected by occupation. CONCLUSIONS: Low back pain is associated with signs of disc degeneration and sciatic pain with posterior disc bulges. Low back pain is strongly associated with occupation.

Low back pain in relation to lumbar disc degeneration

• Objective. —To evaluate the association between white matter changes (leukoaraiosis [LA]) seen on magnetic resonance imaging and cognitive functions. Design. —Survey of cohorts of neurologically healthy elderly subjects derived consecutively from a populationbased random sample. Setting. —General community, the Helsinki (Finland) Aging Brain Study. Subjects. —Cohorts of neurologically healthy subjects aged 55, 60, 65, 70, 75, 80, and 85 years (n=20,18,19,18, 17, 17, and 11 subjects, respectively; total N=120). Measures. —Leukoaraiosis was rated in the periventricular areas (0 to 24) and the centrum semiovale (0 to 24); also, a total LA score was obtained (0 to 48). The neuropsychological test battery covered memory, verbal intellectual and constructional functions, language, speed and attention, and speed of mental processing, as well as simple psychomotor speed. Results. —Low age-related LA scores and deterioration of cognitive functions were obtained in the normal subjects. When controlling for age, we found that speed and attention, together with the speed of mental processing measured by the Trail Making A and the Stroop tests, correlated with the total LA score. However, there was wide variation between subjects. Comparing groups with and without LA proved the association of LA with Trail Making A time, Stroop test result (words/time and difference/time), and the compound score of speed and attention. Presence of periventricular LA was especially related to speed of mental processing. Conclusion. —Leukoaraiosis could explain some of the intellectual impairment in the elderly, especially that of slowing of distinct motor and attentional functions, as well as slowing of mental processing. Mild LA in normal aged subjects could also signal brain at risk for further cognitive impairment.

White matter changes in healthy elderly persons correlate with attention and speed of mental processing.

Background and Purpose We undertook this study to evaluate the frequency and risk factors of white matter hyperintensities seen on T2-weighted MR imaging. We examined cohorts of neurologically nondiseased elderly subjects participating in a general-community study, the Helsinki (Finland) Aging Brain Study. Cohorts of consecutive subjects aged 55, 60, 65, 70, 75, 80, and 85 years (n=20, 18, 20, 18, 19, 18, and 15, respectively; total, n=128) were divided into a young-old (age <75 years, n=76) group and an old-old (age ≥75 years, n=52) group. Methods Frequency of hyperintensities seen on T2-weighted axial and coronal MR images (0.02 T) was rated using a four-point scale in periventricular and centrum semiovale areas. Results The majority of the subjects showed only mild white matter hyperintensities, which were more frequent in the periventricular areas. Age was the most important factor to explain the presence of hyperintensities. A logistic regression analysis related periventricular hyperintensities in t...

White Matter Hyperintensities on MRI in the Neurologically Nondiseased Elderly Analysis of Cohorts of Consecutive Subjects Aged 55 to 85 Years Living at Home

ObjectiveTo relate the expression of HIV regulatory proteins and HIV-specific mRNA in the brain cells of infected individuals with clinical neurological disease.DesignFormalin-fixed postmortem brain tissue from 14 HIV-infected adult patients, with previous repeated neurological and neuroradiological

Abundant expression of HIV Nef and Rev proteins in brain astrocytes in vivo is associated with dementia

Study design Cross-sectional magnetic-resonance imaging (MRI) study. OBJECTIVE To investigate the relation of the lumbosacral transitional vertebra to signs of disc degeneration in MRI and to low back pain (LBP). Summary of background data An association between the transitional vertebra and herniation in the disc above has been found in patients with LBP, but knowledge of the relation to other degenerative disc changes detected in MRI and to LBP is lacking. Methods MR images of the lumbar spine of 138 middle-aged working men and 25 healthy young men were evaluated. The presence and type of lumbosacral transitional vertebra and of degenerative changes in intervertebral discs were evaluated. The history of low back symptoms was obtained with a questionnaire from the middle-aged men. Results The prevalence of transitional vertebra was 30%. Transitional vertebra was associated with an increased risk of degenerative changes in the disc above among the young men and with a decreased risk in the disc below among the middle-aged men. Transitional vertebra, symmetric or asymmetric, was not associated with any type of LBP in the middle-aged men. Conclusions Lumbosacral transitional vertebra increases the risk of early degeneration in the upper disc. This effect seems to be obscured by age-related changes in the middle age. The degenerative process is slowed down in the lower disc. For these effects, the presence of a transitional vertebra should be noticed when morphologic methods are used in research on lumbosacral spine. Transitional vertebra is not associated with any type of LBP.

Raili Raininko

Papers

Low back pain in relation to lumbar disc degeneration

White matter changes in healthy elderly persons correlate with attention and speed of mental processing.

White Matter Hyperintensities on MRI in the Neurologically Nondiseased Elderly Analysis of Cohorts of Consecutive Subjects Aged 55 to 85 Years Living at Home

Abundant expression of HIV Nef and Rev proteins in brain astrocytes in vivo is associated with dementia

Lumbosacral transitional vertebra: relation to disc degeneration and low back pain.