Cerebral microbleeds in dementia with Lewy bodies.

INTRODUCTION: Cerebral microbleeds (CMB) are associated with cognitive impairment and hypertensive or cerebral amyloid angiopathy. The pathophysiology and clinical significance of CMB in dementia with Lewy bodies (DLB) are not well understood. Our study aimed to investigate the prevalence of CMB in DLB and to estimate the magnitudes of their clinical associations. METHODS: Twenty participants with DLB (mean age 74 ± 5 years) were included in this cross-sectional study. All participants underwent 3 T magnetic resonance imaging. CMB number and location were assessed on susceptibility-weighted imaging or quantitative susceptibility mapping. Amyloid-beta (Aß) positron emission tomography (PET) scans were also performed. Between-group comparisons were estimated using risk ratios (RR) for categorical variables, and mean differences or median regression coefficients for continuous variables. RESULTS: CMB were present in 30% of the DLB participants, with a lobar predominance observed. DLB with CMB were more likely to be on antithrombotic therapy (100%), compared to those without CMB (43%; RR 2.33 [95% CI 1.27, 4.27]). Those with CMB were also more likely to report a history of hypertension (100%) compared to those without (70%; RR 1.75 [95% CI 1.11, 2.75]). DLB core clinical features, cognition and functional status did not differ between the two groups. There was no association found between the presence of CMB and cortical Aß deposition on PET imaging. CONCLUSION: CMB are not uncommon in DLB and may be associated with hypertensive small vessel disease. Further studies into the pathophysiology and clinical implications of CMB in DLB are needed.

The influence of cerebrovascular disease in dementia with Lewy bodies and Parkinson's disease dementia.

BACKGROUND AND PURPOSE: Lewy body dementia (LBD), including dementia with Lewy bodies (DLB) and Parkinson's disease dementia, is a common form of neurodegenerative dementia. The frequency and influence of comorbid cerebrovascular disease is not understood but has potentially important clinical management implications. METHODS: A systematic literature search was conducted (MEDLINE and Embase) for studies including participants with DLB and/or Parkinson's disease dementia assessing cerebrovascular lesions (imaging and pathological studies). They included white matter changes, cerebral amyloid angiopathy, cerebral microbleeds (CMB), macroscopic infarcts, microinfarcts and intracerebral haemorrhage. RESULTS: Of 4411 articles, 63 studies were included. Cerebrovascular lesions commonly studied included white matter changes (41 studies) and CMB (18 studies). There was an increased severity of white matter changes on magnetic resonance imaging (visualized as white matter hyperintensities), but not neuropathology, in LBD compared to Parkinson's disease without dementia and age-matched controls. CMB prevalence in DLB was highly variable but broadly similar to Alzheimer's disease (0%-48%), with a lobar predominance. No relationship was found between large cortical or small subcortical infarcts or intracerebral haemorrhage and the presence of LBD. CONCLUSION: The underlying mechanisms of white matter hyperintensities in LBD require further exploration, as their increased severity in LBD was not supported by neuropathological examination of white matter. CMB in LBD had a similar prevalence to Alzheimer's disease. There is a need for larger studies assessing the influence of cerebrovascular lesions on clinical symptoms, disease progression and outcomes.

The use of cerebral imaging for investigating delirium aetiology.

BACKGROUND: This study aims to investigate the frequency and patterns of use of cerebral imaging in delirium and to describe pathological changes associated with delirium using computed tomography (CT) and magnetic resonance imaging (MRI). METHODS: This retrospective observational study included patients with delirium admitted to a tertiary hospital (The Royal Melbourne Hospital, Australia) between January 2015 and August 2016. Data on cerebral imaging was collected and positive imaging findings were defined as: Acute or subacute infarct, haemorrhage, abscess, neoplasm, vasculitis, posterior reversible encephalopathy syndrome, encephalitis, acute demyelination, or fat embolism. RESULTS: There were 1653 (5% of 32,725) patients with delirium (median age 80 years, inter-quartile range 71-86, 54% male). Thirty-three percent (N = 538) had cerebral imaging (CT only: N = 457, MRI only: N = 10, both: N = 71). In 11% (N = 57) of patients, CT brain scans were positive. MRI brain was completed in 17 patients with a positive CT (17/57), changing the diagnosis in two cases. Fifty-four patients with negative CT scans also had MRI brain; 33% (N = 18) of these were positive. Younger patients were more likely to have MRI compared to CT brain scan. Patients admitted to a neurology unit were more likely to have cerebral imaging. CONCLUSION: Use of CT brain was common in delirium patients, with an 11% rate of positive findings. Fewer patients had MRI brain scans, which added diagnostic information in some cases. Future studies are needed to define the significance of cerebral imaging in delirium management and establish guidelines for its use.

Maternal perception of foetal movement compared with movement detected by real-time ultrasound: an exploratory study.

In this exploratory study, women perceived 35.8% of 763 foetal movements seen on 14 ultrasound scans, with increased sensitivity when movements involved more than one foetal body part (adjusted odds ratio (OR) 1.92, 95% confidence interval (CI) 1.232-2.999), contacted the uterus (adjusted OR: 2.57, 95% CI: 1.653-3.995) and were of increasing duration (adjusted OR: 9.33, 95% CI: 5.616-15.513). These findings may inform future studies of the importance of and ability to improve women's perception of foetal movements.

Factors affecting maternal perception of fetal movement.

Maternal perception of fetal movement is an important screening method for fetal well-being, as decreased fetal movement is associated with a range of pregnancy pathologies and poor pregnancy outcomes. An understanding of factors that may affect perception could help clinicians to determine the importance of maternal reports of decreased fetal movement. This review considers factors that may affect maternal perception of fetal movement and the sensitivity of maternal perception of fetal movements in comparison with ultrasound and other objective methods of movement detection. There is conflicting evidence on whether parity, gestational age, overweight and obesity, and placental location affect perception. This may be related to the small sample sizes of available studies and lack of consistent definitions of factors that may affect the ability of mothers to perceive movement. There is some evidence that psychological factors and duration of fetal movement may affect perception, and that strong movements and those including trunk movement are more likely to be perceived. The proportion of fetal breathing movements that mothers perceive has not been investigated. Research is also lacking as to whether there needs to be contact of fetal part(s) with maternal structures for movement to be perceived, and whether fetal position, amniotic fluid volume, maternal position, sedatives, or other drugs affect movement perception.