Publications by authors named "Ilse M J Kant"

10 Publications

  • Page 1 of 1

Determining preoperative brain MRI features and occurrence of postoperative delirium.

J Psychosom Res 2021 Sep 6;148:110568. Epub 2021 Jul 6.

Department of Intensive Care, University Medical Center Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium.

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http://dx.doi.org/10.1016/j.jpsychores.2021.110568DOI Listing
September 2021

Different phenotypes of neuropsychiatric systemic lupus erythematosus are related to a distinct pattern of structural changes on brain MRI.

Eur Radiol 2021 Apr 30. Epub 2021 Apr 30.

Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.

Objectives: The underlying structural brain correlates of neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) remain unclear, thus hindering correct diagnosis. We compared brain tissue volumes between a clinically well-defined cohort of patients with NPSLE and SLE patients with neuropsychiatric syndromes not attributed to SLE (non-NPSLE). Within the NPSLE patients, we also examined differences between patients with two distinct disease phenotypes: ischemic and inflammatory.

Methods: In this prospective (May 2007 to April 2015) cohort study, we included 38 NPSLE patients (26 inflammatory and 12 ischemic) and 117 non-NPSLE patients. All patients underwent a 3-T brain MRI scan that was used to automatically determine white matter, grey matter, white matter hyperintensities (WMH) and total brain volumes. Group differences in brain tissue volumes were studied with linear regression analyses corrected for age, gender, and total intracranial volume and expressed as B values and 95% confidence intervals.

Results: NPSLE patients showed higher WMH volume compared to non-NPSLE patients (p = 0.004). NPSLE inflammatory patients showed lower total brain (p = 0.014) and white matter volumes (p = 0.020), and higher WMH volume (p = 0.002) compared to non-NPSLE patients. Additionally, NPSLE inflammatory patients showed lower white matter (p = 0.020) and total brain volumes (p = 0.038) compared to NPSLE ischemic patients.

Conclusion: We showed that different phenotypes of NPSLE were related to distinct patterns of underlying structural brain MRI changes. Especially the inflammatory phenotype of NPSLE was associated with the most pronounced brain volume changes, which might facilitate the diagnostic process in SLE patients with neuropsychiatric symptoms.

Key Points: • Neuropsychiatric systemic lupus erythematosus (NPSLE) patients showed a higher WMH volume compared to SLE patients with neuropsychiatric syndromes not attributed to SLE (non-NPSLE). • NPSLE patients with inflammatory phenotype showed a lower total brain and white matter volume, and a higher volume of white matter hyperintensities, compared to non-NPSLE patients. • NPSLE patients with inflammatory phenotype showed lower white matter and total brain volumes compared to NPSLE patients with ischemic phenotype.
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http://dx.doi.org/10.1007/s00330-021-07970-2DOI Listing
April 2021

The digital scribe in clinical practice: a scoping review and research agenda.

NPJ Digit Med 2021 Mar 26;4(1):57. Epub 2021 Mar 26.

CAIRELab, Leiden University Medical Center (LUMC), Leiden, The Netherlands.

The number of clinician burnouts is increasing and has been linked to a high administrative burden. Automatic speech recognition (ASR) and natural language processing (NLP) techniques may address this issue by creating the possibility of automating clinical documentation with a "digital scribe". We reviewed the current status of the digital scribe in development towards clinical practice and present a scope for future research. We performed a literature search of four scientific databases (Medline, Web of Science, ACL, and Arxiv) and requested several companies that offer digital scribes to provide performance data. We included articles that described the use of models on clinical conversational data, either automatically or manually transcribed, to automate clinical documentation. Of 20 included articles, three described ASR models for clinical conversations. The other 17 articles presented models for entity extraction, classification, or summarization of clinical conversations. Two studies examined the system's clinical validity and usability, while the other 18 studies only assessed their model's technical validity on the specific NLP task. One company provided performance data. The most promising models use context-sensitive word embeddings in combination with attention-based neural networks. However, the studies on digital scribes only focus on technical validity, while companies offering digital scribes do not publish information on any of the research phases. Future research should focus on more extensive reporting, iteratively studying technical validity and clinical validity and usability, and investigating the clinical utility of digital scribes.
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http://dx.doi.org/10.1038/s41746-021-00432-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997964PMC
March 2021

Preoperative MRI brain phenotypes are related to postoperative delirium in older individuals.

Neurobiol Aging 2021 05 5;101:247-255. Epub 2021 Feb 5.

Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.

The underlying structural correlates of predisposition to postoperative delirium remain largely unknown. A combined analysis of preoperative brain magnetic resonance imaging (MRI) markers could improve our understanding of the pathophysiology of delirium. Therefore, we aimed to identify different MRI brain phenotypes in older patients scheduled for major elective surgery, and to assess the relation between these phenotypes and postoperative delirium. Markers of neurodegenerative and neurovascular brain changes were determined from MRI brain scans in older patients (n = 161, mean age 71, standard deviation 5 years), of whom 24 (15%) developed delirium. A hierarchical cluster analysis was performed. We found six distinct groups of patients with different MRI brain phenotypes. Logistic regression analysis showed a higher odds of developing postoperative delirium in individuals with multi-burden pathology (n = 15 (9%), odds ratio (95% confidence interval): 3.8 (1.1-13.0)). In conclusion, these results indicate that different MRI brain phenotypes are related to a different risk of developing delirium after major elective surgery. MRI brain phenotypes could assist in an improved understanding of the structural correlates of predisposition to postoperative delirium.
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http://dx.doi.org/10.1016/j.neurobiolaging.2021.01.033DOI Listing
May 2021

Preoperative brain MRI features and occurrence of postoperative delirium.

J Psychosom Res 2021 01 16;140:110301. Epub 2020 Nov 16.

Department of Intensive Care Medicine and UMC Utrecht Brain Center, UMC Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, the Netherlands. Electronic address:

Objective: Delirium is a frequent complication after surgery with important negative outcomes for affected patients and society. However, it is still largely unknown why some patients have a predisposition for delirium and others not. To increase our understanding of the neural substrate of postoperative delirium, we studied the association between preoperative brain MRI features and the occurrence of delirium after major surgery.

Methods: A group of 413 patients without dementia (Mean 72 years, SD: 5) was included in a prospective observational two-center study design. The study was conducted at Charité Universitätsmedizin (Berlin, Germany) and the University Medical Center Utrecht (Utrecht, The Netherlands). We measured preoperative brain volumes (total brain, gray matter, white matter), white matter hyperintensity volume and shape, brain infarcts and cerebral perfusion, and used logistic regression analysis adjusted for age, sex, intracranial volume, study center and type of surgery.

Results: Postoperative delirium was present in a total of 70 patients (17%). Preoperative cortical brain infarcts increased the risk of postoperative delirium, although this did not reach statistical significance (OR (95%CI): 1.63 (0.84-3.18). Furthermore, we found a trend for an association of a more complex shape of white matter hyperintensities with occurrence of postoperative delirium (OR (95%CI): 0.97 (0.95-1.00)). Preoperative brain volumes, white matter hyperintensity volume, and cerebral perfusion were not associated with occurrence of postoperative delirium.

Conclusion: Our study suggests that patients with preoperative cortical brain infarcts and those with a more complex white matter hyperintensity shape may have a predisposition for developing delirium after major surgery.
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http://dx.doi.org/10.1016/j.jpsychores.2020.110301DOI Listing
January 2021

Stability of neuropsychological test performance in older adults serving as normative controls for a study on postoperative cognitive dysfunction.

BMC Res Notes 2020 Feb 4;13(1):55. Epub 2020 Feb 4.

Department of Anesthesiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.

Objective: Studies of postoperative cognitive dysfunction (POCD) rely on repeat neuropsychological testing. The stability of the applied instruments, which are affected by natural variability in performance and measurement imprecision, is often unclear. We determined the stability of a neuropsychological test battery using a sample of older adults from the general population. Forty-five participants aged 65 to 89 years performed six computerized and non-computerized neuropsychological tests at baseline and again at 7 day and 3 months follow-up sessions. Mean scores on each test were compared across time points using repeated measures analyses of variance (ANOVA) with pairwise comparison. Two-way mixed effects, absolute agreement analyses of variance intra-class correlation coefficients (ICC) determined test-retest reliability.

Results: All tests had moderate to excellent test-retest reliability during 7-day (ICC range 0.63 to 0.94; all p < 0.01) and 3-month intervals (ICC range 0.60 to 0.92; all p < 0.01) though confidence intervals of ICC estimates were large throughout. Practice effects apparent at 7 days eased off by 3 months. No substantial differences between computerized and non-computerized tests were observed. We conclude that the present six-test neuropsychological test battery is appropriate for use in POCD research though small sample size of our study needs to be recognized as a limitation. Trial registration ClinicalTrials.gov Identifier NCT02265263 (15th October 2014).
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http://dx.doi.org/10.1186/s13104-020-4919-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001199PMC
February 2020

The association between frailty and MRI features of cerebral small vessel disease.

Sci Rep 2019 08 5;9(1):11343. Epub 2019 Aug 5.

Department of Radiology and Brain Center Rudolf Magnus, UMC Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, The Netherlands.

Frailty is a common syndrome in older individuals that is associated with poor cognitive outcome. The underlying brain correlates of frailty are unclear. The aim of this study was to investigate the association between frailty and MRI features of cerebral small vessel disease in a group of non-demented older individuals. We included 170 participants who were classified as frail (n = 30), pre-frail (n = 85) or non-frail (n = 55). The association of frailty and white matter hyperintensity volume and shape features, lacunar infarcts and cerebral perfusion was investigated by regression analyses adjusted for age and sex. Frail and pre-frail participants were older, more often female and showed higher white matter hyperintensity volume (0.69 [95%-CI 0.08 to 1.31], p = 0.03 respectively 0.43 [95%-CI: 0.04 to 0.82], p = 0.03) compared to non-frail participants. Frail participants showed a non-significant trend, and pre-frail participants showed a more complex shape of white matter hyperintensities (concavity index: 0.04 [95%-CI: 0.03 to 0.08], p = 0.03; fractal dimensions: 0.07 [95%-CI: 0.00 to 0.15], p = 0.05) compared to non-frail participants. No between group differences were found in gray matter perfusion or in the presence of lacunar infarcts. In conclusion, increased white matter hyperintensity volume and a more complex white matter hyperintensity shape may be structural brain correlates of the frailty phenotype.
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http://dx.doi.org/10.1038/s41598-019-47731-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683288PMC
August 2019

Basal forebrain cholinergic system volume is associated with general cognitive ability in the elderly.

Neuropsychologia 2018 10 7;119:145-156. Epub 2018 Aug 7.

Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; Pharmaimage Biomarker Solutions GmbH, Robert-Rössle-Straße 10, 13125 Berlin, Germany.

Objective: At the present, it is unclear whether association of basal forebrain cholinergic system (BFCS) volume with cognitive performance exists in healthy as well as in cognitively impaired elderly subjects. Whereas one small study reported an association of BFCS volume with general cognitive ability 'g' in healthy ageing, effects on specific cognitive domains have only been found in subjects with cognitive decline. Here we aim to clarify whether an association of BFCS volume and 'g' is present in a larger sample of elderly subjects without obvious symptoms of dementia and whether similar associations can also be observed in specific cognitive domains.

Methods: 282 pre-surgical patients from the BioCog study (aged 72.7 ± 4.9 years with a range of 65-87 years, 110 women) with a median MMSE score of 29 points (range 24-30) were investigated. BFCS and brain volume as well as brain parenchymal fraction were assessed in T1-weighted MR images using SPM12 and a probabilistic map of the BFCS. Neuropsychological assessment comprised the CANTAB cognitive battery and paper-and-pencil based tests. For data analysis, generalised linear models and quantile regression were applied.

Results: Significant associations of BFCS volume with 'g' and several cognitive domains were found, with the strongest association found for 'g'. BFCS volume explained less variance in cognitive performance than brain volume. The association was not confounded by brain parenchymal fraction. Furthermore, the association of BFCS volume and 'g' was similar in high- and low-performers.

Conclusion: Our results extend previous study findings on BFCS volume associations with cognition in elderly subjects. Despite the observed associations of BFCS volume and cognitive performance, this association seems to reflect a more general association of brain volume and cognition. Accordingly, a specific association of BFCS volume and cognition in non-demented elderly subjects is questionable.
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http://dx.doi.org/10.1016/j.neuropsychologia.2018.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338214PMC
October 2018

The association between brain volume, cortical brain infarcts, and physical frailty.

Neurobiol Aging 2018 10 30;70:247-253. Epub 2018 Jun 30.

Department of Radiology, UMC Utrecht, Utrecht, The Netherlands.

Physical frailty is an age-associated syndrome of decreased reserve leading to vulnerability to physiological stressors and associated with negative outcomes. The underlying structural brain abnormalities of physical frailty are unclear. We investigated the association between brain volume, cortical brain infarcts, and physical frailty. In this multicenter study, 214 nondemented participants were classified as frail (n = 32), prefrail (n = 107), or nonfrail (n = 75) based on the Fried frailty phenotype. The associations between frailty and brain volumes and cortical brain infarcts were investigated by linear or logistic regression analyses. Participants in the frail group showed a lower total brain volume (-19.67 mL [95% confidence interval -37.84 to -1.50]) and lower gray matter volume (-12.19 mL [95% confidence interval -23.84 to -0.54]) compared to nonfrail participants. Frailty was associated with cortical brain infarcts [frail 16% [n = 5], prefrail 11% [n = 12], and nonfrail 3% [n = 2]). Reduced total brain volume and gray matter volume and increased cortical brain infarcts seem therefore to be part of the structural substrate of the physical frailty phenotype.
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http://dx.doi.org/10.1016/j.neurobiolaging.2018.06.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135646PMC
October 2018

MRI Markers of Neurodegenerative and Neurovascular Changes in Relation to Postoperative Delirium and Postoperative Cognitive Decline.

Am J Geriatr Psychiatry 2017 Oct 28;25(10):1048-1061. Epub 2017 Jun 28.

Department of Radiology, UMC, Utrecht, The Netherlands.

Postoperative delirium (POD) and postoperative cognitive decline (POCD) are common in elderly patients. The aim of the present review was to explore the association of neurodegenerative and neurovascular changes with the occurrence of POD and POCD. Fifteen MRI studies were identified by combining multiple search terms for POD, POCD, and brain imaging. These studies described a total of 1,422 patients and were all observational in design. Neurodegenerative changes (global and regional brain volumes) did not show a consistent association with the occurrence of POD (four studies) or POCD (two studies). In contrast, neurovascular changes (white matter hyperintensities and cerebral infarcts) were more consistently associated with the occurrence of POD (seven studies) and POCD (five studies). In conclusion, neurovascular changes appear to be consistently associated with the occurrence of POD and POCD, and may identify patients at increased risk of these conditions. Larger prospective studies are needed to study the consistency of these findings and to unravel the underlying pathophysiological mechanisms.
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http://dx.doi.org/10.1016/j.jagp.2017.06.016DOI Listing
October 2017
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