Improved Recognition of Leukoaraiosis and Cognitive Impairment in Alzheimer's Disease

Jf, Diaz; Merskey, Harold; Hachinski, Vladimir; Dh, Lee; Boniferro, Mary; Cj, Wong; Tr, Mirsen; Fox, Helen

doi:10.1001/archneur.1991.00530220038016

Cited by 78 publications

(41 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, all brain regions of the patient group were hypoperfused, not only the frontal or posterior periventricular areas. White matter changes in frontal or posterior periventricular areas have previously been described as leucoaraiosis in studies using CT on patients with SDAT and other types of dementia, and healthy elderly [7,10,14,21]. In our study, only 5 out of 11 examined cases showed leucoaraiosis.…”

Section: Discussioncontrasting

confidence: 39%

“…Patients with a Hachinski score 67 and a frontal-lobe dementia score 64 according to the rating scale of Gustafsson and Nilsson [31] were excluded. The Mini Mental State Examination (MMSE) was performed in 7 patients and the median value was 8 (range [5][6][7][8][9][10][11][12][13][14]. The other patients were too demented to be tested.…”

Section: Methodsmentioning

confidence: 99%

“…Hypodensities seen on CT of the brain, called leucoaraiosis, and the increased signal intensity in periventricular areas and the centrum semiovale on MRI could be observed in most of the patients with vascular dementia, but also in healthy elderly people, and correlated with age and cerebrovascular risk factors [10,11]. White matter changes have also been revealed using CT and MRI in 25-76% of patients with Alzheimer's dementia, depending on the onset of the disease and on age [12][13][14][15]. The prominence of white matter changes in AD patients with late onset and confusional symptoms in contrast to patients with early onset, predominant cortical signs and often with a genetic predisposition led to suggestions about the heterogeneity of the disease [16].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cerebral Blood Flow in White Matter Is Correlated with Systolic Blood Pressure and EEG in Senile Dementia of the Alzheimer Type

Siennicki-Lantz

Lilja²,

Rosén³

et al. 1997

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

The presence and functional significance of white matter lesions in the ageing brain and in dementia as well as their relation to blood pressure are often discussed. The aim of this study was to evaluate cerebral blood flow in white matter (WMCBF) and its relation to systemic blood pressure and multichannel EEG. WMCBF was measured in 24 elderly women with senile dementia of Alzheimer’s type (SDAT, median age 85.5, range 68–93) and 20 age-matched controls (median age 86.0, range 79–93) using ^99mTc-HMPAO single photon emission CT. A significant low WMCBF could be observed in all analysed regions in SDAT subjects compared to controls, with the greatest decline in the posterior region (parietotemporo-occipital area). Correlations between quantified EEG from the posterior regions and WMCBF were seen. Systolic blood pressure was significantly lower in the SDAT group and was positively correlated with WMCBF in the posterior and anterior brain regions. Whether low systemic blood pressure is the result of cerebral dysfunction is unclear.

show abstract

Section: Discussioncontrasting

confidence: 39%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral Blood Flow in White Matter Is Correlated with Systolic Blood Pressure and EEG in Senile Dementia of the Alzheimer Type

Siennicki-Lantz

Lilja²,

Rosén³

et al. 1997

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

show abstract

“…Indeed, several studies report that WMLs are associated with a history of stroke [6,19,21,23,25,33], the presence of lacunar infarcts [6,7,9,34], heart disease [18,[23][24][25]35], atrial fibrillation [33], peripheral vascular disease [6,18,23], diabetes mellitus [6], risk factors for arteriosclerosis [6], smoking [23] and renal arteriolar sclerosis [3]. However, there are also studies reporting no association with hypertension [33,[35][36][37][38] or blood pressure levels [39,40], and some report associations with low blood pressure [33]. Furthermore, even in studies reporting an association with hypertension, a large proportion of patients do not have hypertension [10,20,22].…”

Section: Arterial Hypertensionmentioning

confidence: 99%

A Review on Blood Pressure and Ischaemic White Matter Lesions

Skoog

1998

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Hypertension or high blood pressure is constantly reported to be the main risk factors for ischaemic white matter lesions (WMLs). These lesions show the histopathological picture of diffuse demyelination and moderate loss of axons in subcortical structures. The main hypothesis regarding the association between high blood pressure and ischaemic WMLs is that long-standing hypertension causes lipohyalinosis of the media and thickening of the vessel walls with narrowing of the lumen of the small perforating arteries and arterioles which nourish the deep white matter. Episodes of hypotension may then lead to hypoperfusion and hypoxia-ischaemia in the white matter. In line with this, low blood pressure has also been reported to be a risk factor for WMLs. However, also other pathogenetic mechanisms may be involved. Hypertension may cause disturbances in the blood-brain barrier, which may cause lesions in the white matter by cerebral oedema, by activation of astrocytes or by destructive enzymes or other poisons which pass through the damaged vessel walls. The renin-angiotensin system is an example of a system that may be involved in the pathogenesis of both hypertension and arteriosclerosis. Its effector peptide angiotensin II has several blood-pressure-increasing effects, such as direct vasoconstriction and activation of the sympathetic nervous system. It also promotes hyperplasia and hypertrophy in vascular smooth muscle cells. Recently an association between hypertension and Alzheimer’s disease has been reported. It is not clear whether this may be the reason for the common occurrence of WMLs in cases of late-onset Alzheimer’s disease, as Alzheimer’s disease may also cause lesions in the cerebral microvasculature. The association between WMLs and hypertension may thus be mediated through several different pathogenetic pathways.

show abstract

“…However, there is evidence suggesting that leuko-araiosis may adversely affect cognition in demented patients and in normal subjects [8, 9, 15, 16, 17, 18, 19, 20, 21]. Magnetic resonance imaging (MRI) is more sensitive to detect white matter lesions.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Leuko-Araiosis and Blood Pressure Variability in the Elderly

Puisieux¹,

Monaca²,

Deplanque³

et al. 2001

Eur Neurol

View full text Add to dashboard Cite

Although leuko-araiosis is a common finding on computed tomographic (CT) scans of the brain, its pathogenesis remains uncertain. To investigate the association between blood pressure (BP) disturbances and leuko-araiosis, we retrospectively reviewed CT scans and 24-hour ambulatory blood pressure monitorings of 79 elderly patients (57 women and 22 men; mean age: 83.3 ± 6.4 years). Of the 79 patients, 50 were demented (30 had Alzheimer’s disease and 18 vascular dementia) and 29 were not demented. The leuko-araiosis score (LA score) was determined by using Rezek’s scale. To evaluate short-term variation of BP, we determined (1) the variability of systolic and diastolic BPs (SBP, DBP; within-subject standard deviation of all readings over a 24-hour period), (2) the coefficient of variability (variability of BP/mean BP) and (3) the maximal variation of BP (difference between the maximum and minimum 24-hour BPs). Higher LA scores were associated with higher SBPs in 24-hour, diurnal and nocturnal periods, higher maximal variation of SBP, greater variability of SBP during 24-hour, diurnal and nocturnal periods and greater coefficient of variability of SBP during sleep. Our study suggests that elevations and short-term variations of SBP may contribute to the pathogenesis of white matter lesions in elderly persons.

show abstract

Improved Recognition of Leukoaraiosis and Cognitive Impairment in Alzheimer's Disease

Cited by 78 publications

References 25 publications

Cerebral Blood Flow in White Matter Is Correlated with Systolic Blood Pressure and EEG in Senile Dementia of the Alzheimer Type

Cerebral Blood Flow in White Matter Is Correlated with Systolic Blood Pressure and EEG in Senile Dementia of the Alzheimer Type

A Review on Blood Pressure and Ischaemic White Matter Lesions

Relationship between Leuko-Araiosis and Blood Pressure Variability in the Elderly

Contact Info

Product

Resources

About