The Cerebrovascular Pathology in Alzheimer's Disease and Its Influence on Clinical Variables

Abstract

Vascular pathology is frequently found in the brains of patients with Alzheimer's disease (AD). The aim of this study is to assess the frequency of vascular pathology in the brain in AD patients in a systematic manner and its clinical significance at presentation. A series of 51 patients with mild to moderate AD were consecutively enrolled. At baseline, every patient underwent the following clinical scales: Mini-Mental, Clinical Dementia Rating Scale, Ischemic Scale, Blessed Dementia Rating Scale, Alzheimer's Disease Assessment Scale Cognitive Subscale, Neuropsychiatric Inventory, and an Activities of Daily Living Scale (Disability Assessment for Dementia). We also carried out magnetic resonance imaging of the brain and color echo Doppler of carotids to measure the intima-media thickness. White matter hyperintensities were quantitatively evaluated with the Wahlund scale. We did not find correlation between intima-media thicknesses of carotids and clinical scales and between the Wahlund scale and clinical scales. The presence or absence of both microinfarctions and hypertension had no influence in the scores of the clinical scales. We conclude that the vascular component is common in AD but only as coincident pathology.

White Matter Hyperintensities and the Course of Depressive Symptoms in Elderly People with Mild Dementia

“…However, other studies did not find such a relationship, although this was based on a combination of psychiatric symptoms rather than a specific measure of depression [10]. Thus, our findings support the hypothesis that WMH predispose elderly individuals, with or without dementia, to developing depression.…”

“…However, a subsequent study failed to identify an association between WMH and psychiatric or other clinical variables in patients with Alzheimer's disease (AD), using a visual scale [10]. Thus, the implications of WMH with regard to incidence and prognosis of depression in subjects with mild dementia are still unclear.…”

Association of White Matter Hyperintensity Measurements on Brain MR Imaging with Cognitive Status, Medial Temporal Atrophy, and Cardiovascular Risk Factors

“…Other cross-sectional studies have also not found an independent association of WMHs to cognitive function. 41,42 Nevertheless, several longitudinal studies do show that the severity of WMHs at baseline is associated with the rate of progression of cognitive impairment, [43][44][45] and at least 1 study has demonstrated that this association is independent of the effects of MTA. 43 However, it is not possible to conclude from these results, as has been done previously, 43 that the faster rate of progression associated with WMHs is related to the synergistic combination of vascular disease, represented by the WMHs, and degenerative disease.…”

Nuevos términos clínicos, prevención y tratamiento del trastorno cognitivo vascular: revisión de literatura basada en la evidencia.

“…El grueso de las evidencias confirma las correlaciones entre edad(13), hipertensión arterial (14,15), hiperhomocisteinemia (16,17), e hiperseñales de sustancia blanca, conocidas también como hiperintensidades de sustancia blanca o LSB en IRM (18,19). El control efectivo de la presión arterial (PA) entre sujetos hipertensos parece disminuir la tasa de progresión de lesiones de sustancia blanca (15).…”