Cerebrovascular Changes and Cerebral Atrophy in the Development of Dementia during Alzheimer's Disease

Abstract

Background: Alzheimer's disease (AD) is the world's number one cerebral neurodegenerative disease. Up to 80% of all dementia cases are due to this disease. AD occurs not only because of impaired metabolism of amyloid beta (Aβ) and tau protein in cerebral tissue, but also in connection with specific disorders of cerebral blood supply, manifested in dyscirculatory angiopathy of Alzheimer's type (DAAT). Aims: The present research focuses on the clinical discovery of the sequence of development of dyscirculatory angiopathy of Alzheimer's type, cerebral atrophy, and dementia in patients with AD and their immediate family members. Methods: 99 patients were selected for the research, of whom: Test Group 1 93 (93.94%) suffered from various stages of AD and severity of dementia (age 34-79 (mean age 67): 32 (34.40%) men, 61 (65.59%) women). Test Group 2 6 (6.06%) children aged 8-12 with a high probability of inheriting AD. Each of them had a parent diagnosed with AD with mild dementia (TDR-1), and a grandparent diagnosed with AD with moderate (TDR-2) or severe dementia (TDR-3). Each child complained of fatigue, memory loss, difficulty in remembering, difficulty in concentrating, and frequent headaches. Results: Test Group 1. According to the severity of dementia and atrophic changes in the temporal lobes, the patients were subdivided: preclinical stage TDR-0 - 10 (10.75%) people, mild stage AD TDR-1 - 26 (27.96%) people, moderately severe stage AD TDR-2-40 (43.01%) people, severe AD TDR-3 - 17 (18.28%) people. We identified dyscirculatory angiopathy of Alzheimer's type in all patients, regardless of their AD stage. Test Group 2. There were no signs of dementia of cognitive disorders in any case. Initial involutive cerebral changes were detected in all 6 (100%) patients. Phenomena similar to DAAT were detected in all 6 (100%) patients. Conclusion: Cerebrovascular changes manifested by dyscirculatory angiopathy of Alzheimer's type, regardless of the stage of the disease, are observed in all patients with AD, as well as in all their young offspring. These changes affect amyloid beta metabolism in the brain and contribute to its deposition and accumulation in cerebral tissue, which leads to neurodegeneration and AD development. The data obtained indicate that dyscirculatory angiopathy of Alzheimer's type is primary and, moreover, possibly congenital in AD development.

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“…The same changes in angioarchitectonics are present in all patients with later clinical stages of AD, TDR-1 -TDR-3 6,7 . Similar changes are detected in childhood in the direct descendants of patients suffering from AD, which indicates the genetically determined, hereditary nature of these changes 7,10 . Studies conducted in recent years have shown that 30 of the 45 major genes associated with the risk of developing Alzheimer's disease are expressed in the cerebral vasculature, which confirms the genetic nature of vascular lesions in AD 11 .…”

“…Dyscirculatory angiopathy of Alzheimer's type refers to cerebral small vessel disease (CSVD); however, this disorder is a complex lesion of the cerebral vascular system, in which not only the microcirculatory, but also the arterial as well as the venous bed suffer 7,8 . These specific cerebrovascular changes appear decades before the first clinical symptoms of the disease.…”

“…These specific cerebrovascular changes appear decades before the first clinical symptoms of the disease. These changes lead to involutive disorders of the temporal lobes and characterize the preclinical stage of AD TDR-0 6,7,9 . The same changes in angioarchitectonics are present in all patients with later clinical stages of AD, TDR-1 -TDR-3 6,7 .…”

“…These changes lead to involutive disorders of the temporal lobes and characterize the preclinical stage of AD TDR-0 6,7,9 . The same changes in angioarchitectonics are present in all patients with later clinical stages of AD, TDR-1 -TDR-3 6,7 . Similar changes are detected in childhood in the direct descendants of patients suffering from AD, which indicates the genetically determined, hereditary nature of these changes 7,10 .…”

“…Dyscirculatory angiopathy of Alzheimer's type affects arteries, arterioles, capillaries, venules and veins and is a hallmark of Alzheimer's disease (AD) 6,7,12 .…”