Comparative Evolution of Alzheimer Disease, Vascular Dementia, and Mixed Dementia

Bowler, John V.; Eliasziw, Michael; Steenhuis, Runa E.; Muñoz, David G.; Fry, Rick; Merskey, Harold; Hachinski, Vladimir

doi:10.1001/archneur.1997.00550180021007

Cited by 72 publications

(55 citation statements)

References 59 publications

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“…This finding is congruent with many other studies that have found failing memory as a classical symptom of early AD. Memory impairment in AD usually precedes other cognitive disabilities [52][53][54] and steadily worsens with progression [4]. FTD rarely begins with a failing memory, and when it occurs, the loss of memory often reflects a general dilapidation in organization and focus, or an anomia [12], rather than a classical amnesia.…”

Section: Discussionmentioning

confidence: 99%

First Symptoms – Frontotemporal Dementia versus Alzheimer’s Disease

Lindau

Almkvist

Kushi³

et al. 2000

Dement Geriatr Cogn Disord

109

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Frontotemporal dementia (FTD) is often misdiagnosed as Alzheimer’s disease (AD). We hypothesized that the first symptoms associated with FTD would be different from those seen in AD and that the first symptoms in FTD would reflect loss of function in the frontal region with the greatest degree of degeneration. The objective of the study was to compare the earliest symptoms in patients with FTD and AD, and to delineate the symptoms that were associated with right, left or bilateral frontotemporal degeneration in FTD. The first symptoms in 52 FTD and 101 AD patients were determined in retrospect. Based on functional imaging studies, the FTD patients were divided into those with predominantly bilateral (n = 15), left-sided (n = 19) and right-sided (n = 18) patterns of atrophy. The results showed that disinhibition, social awkwardness, passivity and loss of executive function were more common in FTD, while memory loss was more common in AD. Disinhibition was greatest in the asymmetric right-sided group, language dysfunction was commonest in the asymmetric left-sided group and loss of executive function was most frequent in the bilateral group. In summary, different first symptoms appeared in FTD and AD, which may help distinguish between the diseases. The anatomic site for FTD largely determined the kind of first symptoms.

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Section: Discussionmentioning

confidence: 99%

First Symptoms – Frontotemporal Dementia versus Alzheimer’s Disease

Lindau

Almkvist

Kushi³

et al. 2000

Dement Geriatr Cogn Disord

109

View full text Add to dashboard Cite

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“…For example, neuropathological data reveal that 30% of patients with a clinical diagnosis of AD were found at postmortem to also have cerebrovascular disease (VaD), and patients with VaD were found at postmortem to show evidence of AD pathology. The distinction between these dementias is thus not complete, perhaps because they share common abnormalities of the endothelial TJ/AJ complexes within the BBB (table 1) [35,36,37]. …”

Section: Vad Ad MD and Dcmentioning

confidence: 99%

Cardiorenal Metabolic Syndrome and Diabetic Cognopathy

et al. 2013

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The prevalence of the cardiorenal metabolic syndrome (CRS) is increasing in parallel with obesity, type 2 diabetes mellitus, Alzheimer's disease, and other forms of dementia. Along with metabolic, inflammatory, and immunological abnormalities, there is maladaptive structural remodeling of the heart, kidney, and brain. The term ‘diabetic cognopathy' (DC) may be used when discussing functional and structural changes in the brain of the diabetic patient. DC likely represents an advanced form of these changes in the brain that evolve with increasing duration of the CRS and subsequent clinical diabetes. We posit that DC develops due to a convergence of aging, genetic and lifestyle abnormalities (overnutrition and lack of exercise), which result in multiple injurious metabolic and immunologic toxicities such as dysfunctional immune responses, oxidative stress, inflammation, insulin resistance, and dysglycemia (systemically and in the brain). These converging abnormalities may lead to endothelial blood-brain barrier tight junction/adherens junction (TJ/AJ) complex remodeling and microglia activation, which may result in neurodegeneration, impaired cognition, and dementia. Herein, we describe the brain ultrastructural changes evolving from a normal state to maladaptive remodeling in rodent models of CRS including microglia activation/polarization and attenuation and/or loss of the TJ/AJ complexes, pericytes and astrocytes of the neurovascular unit. Further, we discuss the potential relationship between these structural changes and the development of DC, potential therapeutic strategies, and future directions.

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“…94,[162][163][164] This problem exists because of overlapping features found in both disorders. For example, AD and VaD share features involving cerebral hypoperfusion, white matter changes, [165][166][167] The similarities of the clinical presentation, pathophysiology, and rate of cognitive decline between AD and VaD have led to the development of treatments that appear useful to both conditions at the level where risk factors are discovered or during the disease process.…”

Section: Ad-vad Correlatesmentioning

confidence: 99%

“…94,[162][163][164] This problem exists because of overlapping features found in both disorders. For example, AD and VaD share features involving cerebral hypoperfusion, white matter changes, [165][166][167] pathophysiological markers, 168 -172 genetic links, [173][174][175][176] overlapping symptomatology, and diagnostic criteria of dubious reliability.…”

Section: Ad-vad Correlatesmentioning

confidence: 99%

Alzheimer Disease as a Vascular Disorder

Torre

2002

Stroke

771

491

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Background-The main stumbling block in the clinical management and in the search for a cure of Alzheimer disease (AD) is that the cause of this disorder has remained uncertain until now. Summary of Review-Evidence that sporadic (nongenetic) AD is primarily a vascular rather than a neurodegenerative disorder is reviewed. This conclusion is based on the following evidence: (1) epidemiological studies showing that practically all risk factors for AD reported thus far have a vascular component that reduces cerebral perfusion; (2) risk factor association between AD and vascular dementia (VaD); (3) improvement of cerebral perfusion obtained from most pharmacotherapy used to reduce the symptoms or progression of AD; (4) detection of regional cerebral hypoperfusion with the use of neuroimaging techniques to preclinically identify AD candidates; (5) presence of regional brain microvascular abnormalities before cognitive and neurodegenerative changes; (6) common overlap of clinical AD and VaD cognitive symptoms; (7) similarity of cerebrovascular lesions present in most AD and VaD patients; (8) presence of cerebral hypoperfusion preceding hypometabolism, cognitive decline, and neurodegeneration in AD; and (9) confirmation of the heterogeneous and multifactorial nature of AD, likely resulting from the diverse presence of vascular risk factors or indicators of vascular disease. Conclusions-Since the value of scientific evidence generally revolves around probability and chance, it is concluded that the data presented here pose a powerful argument in support of the proposal that AD should be classified as a vascular disorder. According to elementary statistics, the probability or chance that all these findings are due to an indirect pathological effect or to coincidental circumstances related to the disease process of AD seems highly unlikely. The collective data presented in this review strongly support the concept that sporadic AD is a vascular disorder. It is recommended that current clinical management of patients, treatment targets, research designs, and disease prevention efforts need to be critically reassessed and placed in perspective in light of these important findings. Key Words: Alzheimer disease Ⅲ dementia Ⅲ microcirculation Ⅲ risk factors Ⅲ vascular disorders A lzheimer disease (AD) is an insidious disorder that progressively ravages the brain, destroying its memory, intellect, and dignity in the process. The main stumbling block in the clinical management and in the search for a cure of AD is that the cause of this disorder has remained uncertain until now. For more than 30 years, AD has been classified and managed as a neurodegenerative disorder, 1,2 following a report by Roth in 1955 3 that suggested that dementia should be classified into 2 distinct disorders according to the variable mental changes caused by each: vascular dementia (VaD), caused by vascular lesions, and AD, resulting from a neurodegenerative process.Most investigators in the field have supported Roth's notion that dementing processes will d...

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Comparative Evolution of Alzheimer Disease, Vascular Dementia, and Mixed Dementia

Cited by 72 publications

References 59 publications

First Symptoms – Frontotemporal Dementia versus Alzheimer’s Disease

First Symptoms – Frontotemporal Dementia versus Alzheimer’s Disease

Cardiorenal Metabolic Syndrome and Diabetic Cognopathy

Alzheimer Disease as a Vascular Disorder

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