Senile Dementia of Alzheimer Type and Multi-Infarct Dementia Investigated by Transcranial Doppler Sonography

Abstract

Dementia of the Alzheimer type, senile onset (SDAT), and multi-infarct dementia (MID) exhibit differences in cerebrovascular blood flow velocity profiles, which were investigated by means of transcranial Doppler sonography. The pulsatility indices (PI), as angle-independent parameters of peripheral vascular resistance measured in the basal cerebral arteries, were significantly increased in MID patients with respect to SDAT cases. In an analysis of the correlations between several variables and the magnitude of PI, we found strong inverse correlations of the CAMCOG score, and strong direct correlations of the blood pressure and the duration of illness, with the PI of all basal cerebral arteries only in MID patients. In SDAT patients, we found a direct correlation between the Hachinski ischemia score and the PI of all basal cerebral arteries. All 3 ischemia scores (Hachinski, Rosen, Loeb and Gandolfo) were significantly correlated with the PI of the middle cerebral and basilar arteries. By analyzing the correlations of the single items of the 3 different ischemia scores with the PI values obtained, we only found a clearcut correlation with the item focal neurological signs. Thus, our findings stress the relative importance of a concomitant cerebrovascular factor in the development of dementia in old age, even in patients with probable SDAT. A raise of the PI in the basal cerebral arteries allows early suspicion of a cerebrovascular factor even in only slight dementia so that possible risk factors for further aggravation of this type of vascular dementia might be detected and treated early in the course of disease.

Neurovascular Deficits in Cocaine Abusers

“…The elevated PI values with slow velocity values observed in 30-to 40-year-old cocaine abusers in the present study was found for 60-year-old individuals (Martin et al 1994). Elevated PI values were also observed in patients with multi-infarct dementia (Biedert et al 1995;Sattel et al 1996) and in hypertensive patients (Cho et al 1997). It is also possible that the decrease in flow velocity might be secondary to changes in the caliber of large vessels.…”

“…Thus, reduced cerebral blood flow velocity might be associated with neuropsychological deficits in a mechanism similar to changes observed in vascular dementia (Biedert et al 1995;Sattel et al 1996;Starkstein et al 1996). This comparison must be made with caution because reduced cerebral blood flow velocity cannot be directly compared with reduced cerebral perfusion.…”

“…Although these subclinical neuropsychiatric deficits may be an indication of increased risk of medi-cal complications, they also characterize cocaine dependence as a neuropsychiatric syndrome (Cadet and Bolla 1996). Moreover, reduced cerebral blood flow may be the underlying cause of the EEG and neuropsychological deficits in a manner similar to vascular dementia (Sattel et al 1996;Starkstein et al 1996). Thus, reduced cerebral blood flow may have been overlooked as a symptom requiring treatment in cocaine abusers (Herning et al 1997a).…”

Methadone Treatment Induces Attenuation of Cerebrovascular Deficits Associated with the Prolonged Abuse of Cocaine and Heroin

“…Studies of pulsatility indices in other patient populations suggest that increased cerebrovascular resistance is because of vasoconstriction of small cortical vessels (Martin et al, 1994, Biedert et al, 1995Cho et al, 1997;Grubb et al, 1998). Patients with multi-infarct dementia have reported mean MCA PI values of 1.27+0.15 (Biedert et al, 1995) and of 1.20 (standard deviation not given) (Sattel et al, 1996). Chronic hypertensives (Cho et al, 1997) and diabetic patients (Lee et al, 2000) have been reported to have PI increases, which correspond to means of 0.89 (standard deviation not given) and 0.87+0.22, respectively.…”

An Algorithmic Approach to the Differential Diagnosis of Dementia

“…Further ex ploration might provide evidence in the former of a new diagnostic category, such as Lewy body dementia [30], which was not yet operationalized, and therefore re mained unidentified, during the CSHA data collection period. The mixed Alzheimerized vascular category is of particular note given recent evidence suggesting a link between AD and VD [40,41]. 328 Dementia l996;7:S24-330…”