{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T04:21:42Z","timestamp":1791692502609,"version":"4.3.4"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>To date, few data to transcranial Doppler sonography (TCD) are available in patients with mild vascular cognitive impairment (VCI) at risk for vascular or mixed dementia. In a previous study in patients with mild VCI and cerebral small vessels disease, a hemodynamic pattern of cerebral hypoperfusion and enhanced vascular resistance were observed; however, longitudinal data are currently lacking. Here, we perform a clinical, psychopathological, and neurosonological follow-up of patients with VCI in order to monitor any progression and to identify TCD measures to detect it.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>From the original cohort of 161 patients, 127 with VCI (mean age 73.6 \u00b1 7.1; 67 males) were re-evaluated after 5.0 \u00b1 1.8 years. Namely, the Montreal Cognitive Assessment (MoCA), the 17-items Hamilton Depression Rating Scale (HDRS), and the Stroop Color-Word Interference Test (StroopT) were administered to screen for global cognitive status, to quantify depressive symptoms, and to explore executive functions, respectively. Mean blood flow velocity (MBFV), peak systolic blood flow velocity (PSV), end-diastolic blood flow velocity (EDV), pulsatility index (PI), and resistivity index (RI) were recorded from the middle cerebral artery, bilaterally.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>At follow up, patients exhibited a significant worsening of both MoCA (21.7 \u00b1 2.1 <jats:italic>vs<\/jats:italic>. 20.7 \u00b1 2.0) and StroopT scores (57.4 \u00b1 19.4 <jats:italic>vs<\/jats:italic>. 59.7 \u00b1 18.6), whereas HDRS showed an improvement, although the mean raw score remained above the cut-off value for depression (10.3 \u00b1 6.6 <jats:italic>vs<\/jats:italic>. 9.8 \u00b1 6.3). MBFV, PSV, and EDV showed a significant increase in PSV and PI and a reduction in EDV. When focused to younger patients (&lt;65 years), we confirmed the significant worsening of both MoCA and StroopT but not HDRS, as well as the significant changes in PI and RI. Finally, considering the differences (D) between baseline and follow-up, the following significant correlations emerged, although with a small-to-medium effect size for all of them: positive correlation between MBFV-D and MoCA-D and between RI-D and STROOP-D, and a negative significant correlation between RI-D and MoCA-D.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Notwithstanding some limitations, such as the lack of a control group and neuroimaging data at follow-up, TCD may contribute to the early detection, monitoring, and management of VCI patients at risk for dementia. Together with compatible clinical and cognitive features, the exploration of early TCD markers that possibly indicate a higher risk of progression might represent an intriguing research direction and a significant clinical perspective.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317888","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T18:27:01Z","timestamp":1737743221000},"page":"e0317888","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Transcranial Doppler sonography follow-up study in mild vascular cognitive impairment"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9072-4971","authenticated-orcid":true,"given":"Mariagiovanna","family":"Cantone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Pennisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5659-662X","authenticated-orcid":true,"given":"Giuseppe","family":"Lanza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6937-3065","authenticated-orcid":true,"given":"Raffaele","family":"Ferri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Fisicaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Cappellani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"David","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Nicosia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klizia","family":"Cortese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Pennisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Puglisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Bella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"issue":"1","key":"pone.0317888.ref001","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1177\/17474930221144911","article-title":"Cerebral small vessel disease: Recent advances and future directions","volume":"18","author":"HS Markus","year":"2023","journal-title":"Int J Stroke Off J Int Stroke Soc"},{"issue":"4","key":"pone.0317888.ref002","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1212\/WNL.0000000000000612","article-title":"Structural network efficiency is associated with cognitive impairment in small-vessel disease","volume":"83","author":"AJ Lawrence","year":"2014","journal-title":"Neurology"},{"issue":"3","key":"pone.0317888.ref003","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1159\/000272003","article-title":"Clinical presentation and outcome of geriatric depression in subcortical ischemic vascular disease","volume":"56","author":"R Bella","year":"2010","journal-title":"Gerontology"},{"issue":"8","key":"pone.0317888.ref004","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1161\/CIRCRESAHA.122.319951","article-title":"Post-Stroke Cognitive Impairment and Dementia","volume":"130","author":"NS Rost","year":"2022","journal-title":"Circ Res"},{"issue":"11","key":"pone.0317888.ref005","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1016\/j.jalz.2018.04.007","article-title":"Cerebral small vessel disease and the risk of dementia: A systematic review and meta-analysis of population-based evidence","volume":"14","author":"D Bos","year":"2018","journal-title":"Alzheimers Dement J Alzheimers Assoc"},{"key":"pone.0317888.ref006","doi-asserted-by":"crossref","first-page":"2941","DOI":"10.2147\/JPR.S209485","article-title":"Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review","volume":"12","author":"L Vinciguerra","year":"2019","journal-title":"J Pain Res"},{"issue":"8","key":"pone.0317888.ref007","doi-asserted-by":"crossref","first-page":"546","DOI":"10.3390\/brainsci10080546","article-title":"Cerebral Hemodynamic Changes to Transcranial Doppler in Asymptomatic Patients with Fabry\u2019s Disease","volume":"10","author":"C Vagli","year":"2020","journal-title":"Brain Sci"},{"key":"pone.0317888.ref008","doi-asserted-by":"crossref","first-page":"931727","DOI":"10.3389\/fnhum.2022.931727","article-title":"Cerebral hemodynamic changes to transcranial Doppler sonography in celiac disease: A pilot study","volume":"16","author":"F Fisicaro","year":"2022","journal-title":"Front Hum Neurosci"},{"issue":"7","key":"pone.0317888.ref009","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1007\/s00134-019-05610-4","article-title":"Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review","volume":"45","author":"C Robba","year":"2019","journal-title":"Intensive Care Med"},{"key":"pone.0317888.ref010","doi-asserted-by":"crossref","first-page":"841809","DOI":"10.3389\/fnhum.2022.841809","article-title":"Transcranial Doppler Ultrasonography as a Diagnostic Tool for Cerebrovascular Disorders","volume":"16","author":"Y Pan","year":"2022","journal-title":"Front Hum Neurosci"},{"issue":"1","key":"pone.0317888.ref011","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1159\/000339234","article-title":"Cerebrovascular function in aging and dementia: a systematic review of transcranial Doppler studies","volume":"2","author":"HAD Keage","year":"2012","journal-title":"Dement Geriatr Cogn Disord Extra"},{"issue":"5\u20136","key":"pone.0317888.ref012","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1159\/000535422","article-title":"Cerebrovascular Hemodynamics in Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of Transcranial Doppler Studies","volume":"52","author":"D Fresnais","year":"2023","journal-title":"Dement Geriatr Cogn Disord"},{"issue":"4","key":"pone.0317888.ref013","doi-asserted-by":"crossref","first-page":"e0216162","DOI":"10.1371\/journal.pone.0216162","article-title":"Transcranial Doppler ultrasound in vascular cognitive impairment-no dementia","volume":"14","author":"L Vinciguerra","year":"2019","journal-title":"PloS One"},{"issue":"3","key":"pone.0317888.ref014","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/WAD.0000000000000034","article-title":"Diagnostic criteria for vascular cognitive disorders: a VASCOG statement","volume":"28","author":"P Sachdev","year":"2014","journal-title":"Alzheimer Dis Assoc Disord"},{"issue":"4","key":"pone.0317888.ref015","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"ZS Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"pone.0317888.ref016","doi-asserted-by":"crossref","first-page":"557","DOI":"10.3389\/fpsyg.2017.00557","article-title":"The Stroop Color and Word Test","volume":"8","author":"F Scarpina","year":"2017","journal-title":"Front Psychol"},{"issue":"6","key":"pone.0317888.ref017","first-page":"443","article-title":"Rey-Osterrieth complex figure: normative values in an Italian population sample","volume":"22","author":"P Caffarra","year":"2002","journal-title":"Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol"},{"issue":"4","key":"pone.0317888.ref018","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1093\/occmed\/kqv043","article-title":"The Hamilton Rating Scale for Depression","volume":"65","author":"R Sharp","year":"2015","journal-title":"Occup Med Oxf Engl"},{"key":"pone.0317888.ref019","first-page":"567","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"J Cohen","year":"1988","edition":"2"},{"issue":"1","key":"pone.0317888.ref020","doi-asserted-by":"crossref","first-page":"369","DOI":"10.3233\/JAD-170181","article-title":"Cerebral Hemodynamics in Mild Cognitive Impairment: A Systematic Review","volume":"59","author":"L Beishon","year":"2017","journal-title":"J Alzheimers Dis JAD"},{"issue":"7","key":"pone.0317888.ref021","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1038\/nrn.2017.48","article-title":"Cerebral blood flow regulation and neurovascular dysfunction in Alzheimer disease","volume":"18","author":"K Kisler","year":"2017","journal-title":"Nat Rev Neurosci"},{"issue":"6","key":"pone.0317888.ref022","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1002\/ana.20493","article-title":"Cerebral hypoperfusion and clinical onset of dementia: the Rotterdam Study","volume":"57","author":"A Ruitenberg","year":"2005","journal-title":"Ann Neurol"},{"issue":"4","key":"pone.0317888.ref023","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1159\/000078503","article-title":"Cerebral haemodynamics in the elderly: the rotterdam study","volume":"23","author":"SLM Bakker","year":"2004","journal-title":"Neuroepidemiology"},{"issue":"5","key":"pone.0317888.ref024","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1007\/s00424-020-02508-9","article-title":"Vascular and haemodynamic issues of brain ageing","volume":"473","author":"L Beishon","year":"2021","journal-title":"Pflugers Arch"},{"issue":"1","key":"pone.0317888.ref025","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12916-017-0799-3","article-title":"Ultrasound and dynamic functional imaging in vascular cognitive impairment and Alzheimer\u2019s disease","volume":"15","author":"B Malojcic","year":"2017","journal-title":"BMC Med"},{"key":"pone.0317888.ref026","doi-asserted-by":"crossref","first-page":"S259","DOI":"10.3233\/JAD-132507","article-title":"Ultrasound subclinical markers in assessing vascular changes in cognitive decline and dementia","volume":"42 Suppl 3","author":"V Demarin","year":"2014","journal-title":"J Alzheimers Dis JAD"},{"key":"pone.0317888.ref027","doi-asserted-by":"crossref","first-page":"S251","DOI":"10.3233\/JAD-132441","article-title":"The role of neurosonology in the diagnosis of vascular dementia","volume":"42 Suppl 3","author":"G Tsivgoulis","year":"2014","journal-title":"J Alzheimers Dis JAD"},{"issue":"1","key":"pone.0317888.ref028","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1177\/0271678X16671146","article-title":"The capillary bed offers the largest hemodynamic resistance to the cortical blood supply","volume":"37","author":"IG Gould","year":"2017","journal-title":"J Cereb Blood Flow Metab Off J Int Soc Cereb Blood Flow Metab"},{"issue":"6","key":"pone.0317888.ref029","first-page":"448","article-title":"White-gray matter echogenicity ratio and resistive index: sonographic bedside markers of cerebral hypoxic-ischemic injury\/edema?","volume":"32","author":"PS Pinto","year":"2012","journal-title":"J Perinatol Off J Calif Perinat Assoc"},{"issue":"3","key":"pone.0317888.ref030","doi-asserted-by":"crossref","first-page":"221","DOI":"10.2223\/JPED.1488","article-title":"Cranial Doppler resistance index measurement in preterm newborns with cerebral white matter lesion","volume":"82","author":"N Argollo","year":"2006","journal-title":"J Pediatr (Rio J)"},{"key":"pone.0317888.ref031","article-title":"Quantification of brain-wide vascular resistivity via ultrafast Doppler in human neonates helps early detection of white matter injury","author":"F Faure","year":"2024","journal-title":"J Cereb Blood Flow Metab Off J Int Soc Cereb Blood Flow Metab"},{"issue":"5","key":"pone.0317888.ref032","doi-asserted-by":"crossref","first-page":"709","DOI":"10.3390\/brainsci13050709","article-title":"Altered Cerebral Vasoreactivity on Transcranial Color-Coded Sonography Related to Akinetic-Rigid Phenotype of Parkinson\u2019s Disease: Interim Analysis of a Cross-Sectional Study","volume":"13","author":"RT Brisson","year":"2023","journal-title":"Brain Sci"},{"issue":"3","key":"pone.0317888.ref033","doi-asserted-by":"crossref","first-page":"264","DOI":"10.5152\/tjg.2016.15446","article-title":"Cerebral hemodynamics in patients with cirrhosis","volume":"27","author":"\u00c7 \u00d6ncel","year":"2016","journal-title":"Turk J Gastroenterol Off J Turk Soc Gastroenterol"},{"issue":"1","key":"pone.0317888.ref034","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1148\/radiol.2017172090","article-title":"Increased Rather than Decreased Small Vessel Pulsatility in Patients with Progressing Cerebral White Matter Hyperintensities","volume":"286","author":"JJM Zwanenburg","year":"2018","journal-title":"Radiology"},{"issue":"2","key":"pone.0317888.ref035","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.arr.2011.12.009","article-title":"Cerebrovascular hemodynamics in Alzheimer\u2019s disease and vascular dementia: a meta-analysis of transcranial Doppler studies","volume":"11","author":"B Sabayan","year":"2012","journal-title":"Ageing Res Rev"},{"key":"pone.0317888.ref036","doi-asserted-by":"crossref","first-page":"1179069518801291","DOI":"10.1177\/1179069518801291","article-title":"Retinal Vascular Imaging in Vascular Cognitive Impairment: Current and Future Perspectives","volume":"12","author":"OM Dumitrascu","year":"2018","journal-title":"J Exp Neurosci"},{"key":"pone.0317888.ref037","doi-asserted-by":"crossref","first-page":"1294432","DOI":"10.3389\/fmed.2024.1294432","article-title":"COVID-19-related retinal microvasculopathy and systemic implications in patients with severe disease: results from the Methuselah study","volume":"11","author":"N Castellino","year":"2024","journal-title":"Front Med"},{"issue":"8","key":"pone.0317888.ref038","first-page":"523","article-title":"[THE RETINA AS A TOOL FOR EARLY DIAGNOSIS OF ALZHEIMER DISEASE]","volume":"161","author":"K Wood","year":"2022","journal-title":"Harefuah"},{"issue":"4","key":"pone.0317888.ref039","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1212\/WNL.57.4.714","article-title":"Progression of impairment in patients with vascular cognitive impairment without dementia","volume":"57","author":"C Wentzel","year":"2001","journal-title":"Neurology"},{"issue":"1","key":"pone.0317888.ref040","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s40478-023-01590-1","article-title":"Chronic cerebral hypoperfusion: a critical feature in unravelling the etiology of vascular cognitive impairment","volume":"11","author":"V Rajeev","year":"2023","journal-title":"Acta Neuropathol Commun"},{"issue":"7","key":"pone.0317888.ref041","first-page":"CD010783","article-title":"Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI)","volume":"7","author":"I Arevalo-Rodriguez","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"issue":"25","key":"pone.0317888.ref042","first-page":"3326","article-title":"Vascular Cognitive Impairment and Dementia: JACC Scientific Expert Panel","volume":"73","author":"C Iadecola","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"pone.0317888.ref043","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/B978-0-12-804766-8.00020-0","article-title":"Vascular cognitive impairment: A preventable component of dementia","volume":"167","author":"MR Azarpazhooh","year":"2019","journal-title":"Handb Clin Neurol"},{"issue":"6","key":"pone.0317888.ref044","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1007\/s11883-013-0330-z","article-title":"Vascular cognitive impairment","volume":"15","author":"MU Farooq","year":"2013","journal-title":"Curr Atheroscler Rep"},{"issue":"4","key":"pone.0317888.ref045","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1017\/S1041610218001370","article-title":"Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer\u2019s Disease (AD) in the elderly?","volume":"31","author":"TCC Pinto","year":"2019","journal-title":"Int Psychogeriatr"},{"issue":"1","key":"pone.0317888.ref046","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1038\/s41398-019-0514-6","article-title":"Mechanisms and treatment of late-life depression","volume":"9","author":"GS Alexopoulos","year":"2019","journal-title":"Transl Psychiatry"},{"key":"pone.0317888.ref047","volume-title":"Dementia and Geriatric Cognitive Disorders","year":"2024"},{"issue":"10161","key":"pone.0317888.ref048","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1016\/S0140-6736(18)31948-2","article-title":"Depression","volume":"392","author":"GS Malhi","year":"2018","journal-title":"Lancet Lond Engl"},{"issue":"2","key":"pone.0317888.ref049","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/S2215-0366(16)30263-2","article-title":"Why is depression more common among women than among men?","volume":"4","author":"C Kuehner","year":"2017","journal-title":"Lancet Psychiatry"},{"issue":"3","key":"pone.0317888.ref050","doi-asserted-by":"crossref","first-page":"e0282751","DOI":"10.1371\/journal.pone.0282751","article-title":"Sex differences in mild vascular cognitive impairment: A multimodal transcranial magnetic stimulation study","volume":"18","author":"M Cantone","year":"2023","journal-title":"PloS One"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317888","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T18:27:28Z","timestamp":1737743248000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317888"}},"subtitle":[],"editor":[{"given":"Alon","family":"Harris","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,24]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0317888","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,24]]}}}