Clive Beggs / Zivadinov research on reflux in Alzheimers

[Cece]

Jugular venous reflux and brain parenchyma volumes in elderly patients with mild cognitive impairment and Alzheimer's disease

Clive Beggs, Chih-Ping Chung, Niels Bergsland, Pei-Ning Wang, Simon Shepherd, Chun-Yu Cheng, Michael G Dwyer, Han-Hwa Hu and Robert Zivadinov

BMC Neurology 2013, 13:157 doi:10.1186/1471-2377-13-157
Published: 31 October 2013
Abstract (provisional)

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. 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.

This was published a week ago. I just saw it today. Really interesting.

[cheerleader]

What's SUPER cool is that the Taiwanese team, who have been looking at jugular reflux, jugular insufficiency and transient global amnesia, are also part of the research. http://www.thisisms.com/forum/chronic-c ... 14138.html

One thing patients, caregivers, and CCSVI advocates can be truly proud of, is that fact that we've helped introduce these researchers to each other, thru this forum, and in contacting them individually. The ISNVD is bringing together stellar multi-modal teams.

It was interesting to see that brains did not show signs of atrophy, and were, in fact larger than expected. Whether this is due to edema, or insufficiency of CSF flow is to be discovered. But there is really something to the importance of the jugular veins, and venous return to brain health.
cheer

[1eye]

All these counter-intuitive results... it seems we're on a definite trail of some kind. A result like this for Alzheimer's patients shows the medical world they ignore CCSVI at their peril. Same for most CSF and venous circulation issues.

[Rogan]

So the big question. Does anyone know of an Alzheimer's patient who has undergone venoplasty to help restore normal blood flow in the internal jugulars?

[drsclafani]

Jugular venous reflux and brain parenchyma volumes in elderly patients with mild cognitive impairment and Alzheimer's disease

Clive Beggs, Chih-Ping Chung, Niels Bergsland, Pei-Ning Wang, Simon Shepherd, Chun-Yu Cheng, Michael G Dwyer, Han-Hwa Hu and Robert Zivadinov

BMC Neurology 2013, 13:157 doi:10.1186/1471-2377-13-157
Published: 31 October 2013
Abstract (provisional)

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. 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.

This was published a week ago. I just saw it today. Really interesting.

i would want to know what they mean by JVR. is it due to an incompetent jugular valve with blood flow extending retrograde from the heart up the jugular vein or is it like in MS where there is really reversal of flow above the valve

we remain in a conundrum regarding a definition of reflux

[cheerleader]

i would want to know what they mean by JVR. is it due to an incompetent jugular valve with blood flow extending retrograde from the heart up the jugular vein or is it like in MS where there is really reversal of flow above the valve

we remain in a conundrum regarding a definition of reflux

Hi Dr. S--
the whole paper is available online here:
http://www.biomedcentral.com/content/pd ... 13-157.pdf
This is retrograde flow, under valsalva maneuver---which as you well know, is not CCSVI. The paper explains this.
I think Zamboni, and you and others have been pretty clear that CCSVI in MS occurs without VM.

The Taiwanese researchers (Chung et al) have been looking at JVR and valve incompetence under valsalva in TIA, leukaraiosis and in aging populations for about five years. So, this is a pressurized, or forced reflux. But it's interesting to see that the brain changes were not atrophy, but looked more like edema from reduced CSF flow.
We're finally looking at how venous return, not just carotid delivery, affects the brain.

cheer

[Cece]

So the big question. Does anyone know of an Alzheimer's patient who has undergone venoplasty to help restore normal blood flow in the internal jugulars?

Ok, so if it is reflux due to flopsy IJV valves that let backflow reflux from the heart back up to the brain, instead of reflux due to abrupt blockages of flow due to thickened valves, then how do you treat that? It's not venoplasty, because the valve is already flopsy. There's no replacement valves to graft in, although that might be a blue sky idea. If it's edema of the brain, would Diomax help? Being conscious of the problem so as to avoid valsalva conditions could help. Otherwise there doesn't seem to be as straight-forward of a treatment as what there is for us, with venoplasty.

One thing patients, caregivers, and CCSVI advocates can be truly proud of, is that fact that we've helped introduce these researchers to each other, thru this forum, and in contacting them individually. The ISNVD is bringing together stellar multi-modal teams.

It's really good to see this happening.

[Rogan]

I feel like Zamboni’s break-through is leading to a whole new way of looking at unexplained neurological disease.

This is fascinating stuff. In addition to the latest research coming out, by which neurosurgeons perform angioplasty on the small arteries in the backs of Alzheimer patients’ necks, and then the flow problem shifts to somewhere else in the artery system.

I wonder if these researchers with Beggs have checked perfusion yet in pwAlz. They have been looking at this for 5 years.

As Dr. Hubbard is telling us.

Got MS? Have you checked your perfusion yet?