title: Jugular venous reflux and brain parenchyma volumes in elderly patients with mild cognitive impairment and Alzheimer's disease.
abstract: BACKGROUND
  To determine whether or not jugular venous reflux (JVR) is associated with structural brain parenchyma changes in individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD).
  
  
  METHODS
  16 AD patients (mean (SD): 81.9 (5.8) years), 33 MCI patients (mean (SD): 81.4 (6.1) years) and 18 healthy elderly controls (mean (SD): 81.5 (3.4) years) underwent duplex ultrasonography and magnetic resonance imaging scans to quantify structural brain parenchyma changes. Normalized whole brain (WB), gray matter (GM) and white matter (WM) volumes were collected, together with CSF volume.
  
  
  RESULTS
  JVR was strongly associated with increased normalized WB (p = 0.014) and GM (p = 0.002) volumes across all three subject groups. There was a trend towards increased WB and GM volumes, which was accompanied by decreased CSF volume, in the JVR-positive subjects in both the MCI and AD groups. When the MCI and AD subjects were aggregated together significant increases were observed in both normalized WB (p = 0.009) and GM (p = 0.003) volumes for the JVR-positive group. No corresponding increases were observed for the JVR-positive subjects in the control group. Through receiver operating characteristic analysis of the brain volumetric data it was possible to discriminate between the JVR-positive and negative AD subjects with reasonable accuracy (sensitivity = 71.4%; specificity = 88.9%; p = 0.007).
  
  
  CONCLUSIONS
  JVR is associated with intracranial structural changes in MCI and AD patients, which result in increased WB and GM volumes. The neuropathology of this unexpected and counterintuitive finding requires further investigation, but may suggest that JVR retrogradely transmits venous hypertension into the brain and leads to brain tissues swelling due to vasogenic edema.
authors.affiliation: Medical Biophysics Laboratory, School of Engineering, Design & Technology, University of Bradford, Bradford, West Yorkshire BD7 1DP, UK. c.b.beggs@bradford.ac.uk.
authors.forename: Clive
authors.initials: C
authors.lastname: Beggs
authors.forename: Chih-Ping
authors.initials: CP
authors.lastname: Chung
authors.forename: Niels
authors.initials: N
authors.lastname: Bergsland
authors.forename: Pei-Ning
authors.initials: PN
authors.lastname: Wang
authors.forename: Simon
authors.initials: S
authors.lastname: Shepherd
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Cheng
authors.forename: Michael G
authors.initials: MG
authors.lastname: Dwyer
authors.forename: Han-Hwa
authors.initials: HH
authors.lastname: Hu
authors.forename: Robert
authors.initials: R
authors.lastname: Zivadinov
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology*; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D013624:Taiwan / Q000453:epidemiology