Imaging Interactions between Alzheimer's Disease and Cerebrovascular Disease

The objective of this study was to investigate the cross-sectional associations of atrial fibrillation with neuroimaging measures of cerebrovascular disease and Alzheimer’s disease-related pathology, and their interaction with cognitive impairment. MRI scans of non-demented individuals (n=1044) from the population-based Mayo Clinic Study of Aging were analyzed for infarctions, total grey matter, hippocampal and white matter hyperintensity volumes. A subset of 496 individuals underwent FDG and C-11 Pittsburgh compound B (PiB) PET scans. We assessed the associations of atrial fibrillation with i) categorical MRI measures (cortical and subcortical infarctions) using multivariable logistic regression models, and with ii) continuous MRI measures ( hippocampal, total grey matter, and white matter hyperintensity volumes) and FDG-PET and PiB-PET measures using multivariable linear regression models, and adjusting for confounders. Among participants who underwent MRI (median age, 77.8, 51.6% male), 13.5% had atrial fibrillation. Presence of atrial fibrillation was associated with subcortical infarctions (odds ratio [OR], 1.83; p=0.002), cortical infarctions (OR, 1.91; p=0.03), total grey matter volume (Beta [β], -.025, p<.0001) after controlling for age, education, gender, APOE e4 carrier status, coronary artery disease, diabetes, history of clinical stroke, and hypertension. However, atrial fibrillation was not associated with white matter hyperintensity volume, hippocampal volume, Alzheimer’s pattern of FDG hypometabolism or PiB uptake. There was a significant interaction of cortical infarction (p for interaction=0.004) and subcortical infarction (p for interaction =0.015) with atrial fibrillation with regards to odds of mild cognitive impairment (MCI). Using subjects with no atrial fibrillation and no infarction as the reference, the OR (95% confidence intervals [CI]) for MCI was 2.98 (1.66, 5.35;p = 0.0002) among participants with atrial fibrillation and any infarction, 0.69 (0.36, 1.33;p= 0.27) for atrial fibrillation and no infarction, and 1.50 (0.96, 2.32;p = 0.07) for no atrial fibrillation and any infarction. These data highlight that atrial fibrillation is associated with MCI in the presence of infarctions.

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Biobank innovations for chronic cerebrovascular disease with Alzheimer's disease study (BICWALZS)

Alzheimer s & Dementia ◽

10.1002/alz.042259 ◽

2020 ◽

Vol 16 (S2) ◽

Author(s):

Sang Joon Son ◽

Bumhee Park ◽

Hyung Woong Roh ◽

Narae Kim ◽

Yong Hyuk Jo ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebrovascular Disease ◽

Disease Study

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Good rate of clinical response to cholinesterase inhibitors in mild and moderate Alzheimer's disease after three months of treatment: An open-label study

Dementia & Neuropsychologia ◽

10.1590/s1980-57642013dn70200009 ◽

2013 ◽

Vol 7 (2) ◽

pp. 190-196 ◽

Cited By ~ 2

Author(s):

Luis Felipe José Ravic de Miranda ◽

Marilourdes do Amaral Barbosa ◽

Patrícia Regina Henrique Peles ◽

Patrícia Hilar Pôças ◽

Pedro Augusto Lopes Tito ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebrovascular Disease ◽

Clinical Response ◽

Cholinesterase Inhibitors ◽

Rating Scale ◽

The Elderly ◽

Open Label ◽

Age Related ◽

Moderate Dementia

ABSTRACT Life expectancy in Brazil has increased markedly over the last 30 years. Hence, age-related disorders, such as Alzheimer's disease (AD), warrant special attention due to their high prevalence in the elderly. Pharmacologic treatment of AD is based on cholinesterase inhibitors (ChEI) and memantine, leading to modest clinical benefits both in the short and long-term. However, clinical response is heterogeneous and needs further investigation. Objective: To investigate the rate of response to ChEI in AD after three months of treatment. Methods: Patients with mild or moderate dementia due to probable AD or to AD associated with cerebrovascular disease were included in the study. The subjects were assessed at baseline and again after three months of ChEI treatment. Subjects were submitted to the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale, Katz Basic Activities of Daily Living, Pfeffer Functional Activities Questionnaire, Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Good response was defined by a gain of ≥2 points on the MMSE after three months of treatment in relation to baseline. Results: Seventy-one patients, 66 (93%) with probable AD and five (7%) with AD associated with cerebrovascular disease, were evaluated. The good response rate at three months was 31.0%, being 37.2% and 21.4% in mild and moderate dementia, respectively. There were no significant differences on most tests, except for improvement in hallucinations, agitation and dysphoria in moderate dementia patients. Conclusion: The rate of good clinical response to ChEI was higher than usually reported. Specific behavioral features significantly improved in the subgroup of moderate dementia.

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Linguistic Ability in Early Life and the Neuropathology of Alzheimer's Disease and Cerebrovascular Disease: Findings from the Nun Study

Annals of the New York Academy of Sciences ◽

10.1111/j.1749-6632.2000.tb06347.x ◽

2000 ◽

Vol 903 (1 VASCULAR FACT) ◽

pp. 34-38 ◽

Cited By ~ 79

Author(s):

D. A. SNOWDON ◽

L. H. GREINER ◽

W. R. MARKESBERY

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebrovascular Disease ◽

Early Life ◽

Linguistic Ability ◽

Nun Study

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Effect of galantamine on attention in patients with Alzheimer's disease combined with cerebrovascular disease

Geriatrics and Gerontology International ◽

10.1111/ggi.12934 ◽

2016 ◽

Author(s):

Jeong Jin Park ◽

Seong Hye Choi ◽

SangYun Kim ◽

Ae Young Lee ◽

So Young Moon ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebrovascular Disease

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Hemodynamics in Alzheimer’s Disease and Vascular Cognitive Impairment and Dementia

Vascular Disease, Alzheimer's Disease, and Mild Cognitive Impairment ◽

10.1093/oso/9780190634230.003.0014 ◽

2020 ◽

pp. 302-330

Author(s):

Francis Cambronero ◽

Angela L. Jefferson

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Cerebrovascular Disease ◽

Vascular System ◽

Clinical Symptoms ◽

Vascular Dysfunction ◽

Critical Role ◽

Vascular Cognitive Impairment ◽

Aging Adults

Hemodynamic impairment is a prominent feature in aging, vascular cognitive impairment and dementia, and Alzheimer’s disease, including patterned changes in cerebral blood flow (CBF) that can be detected prior to concomitant pathologies. These CBF abnormalities drive vascular dysfunction through a variety of biological pathways and ultimately contribute to cerebrovascular disease associated with cognitive impairment. Importantly, the co-existence of cerebrovascular disease and Alzheimer’s disease is exceedingly common and worsens the progression of clinical symptoms, likely through accelerating neurotoxic protein deposition and the loss of cerebrovascular integrity. Emerging evidence further suggests that the brain may be more susceptible to subclinical cardiovascular dysfunction in aging adults, particularly since the accumulation of cardiovascular risk factors over the lifespan creates a more vulnerable vascular system. Although age-associated CBF dysregulation has varied and complex origins, it undoubtedly serves a critical role in the early progression of neurodegenerative disease and may help explain the considerable overlap between the most common clinical dementias.

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Structural MRI in Alzheimer’s Disease

Vascular Disease, Alzheimer's Disease, and Mild Cognitive Impairment ◽

10.1093/oso/9780190634230.003.0010 ◽

2020 ◽

pp. 208-240

Author(s):

Briana S. Last ◽

Batool Rizvi ◽

Adam M. Brickman

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebrovascular Disease ◽

Cognitive Aging ◽

Structural Mri ◽

The Other ◽

Aging Brain ◽

Medial Temporal Lobes ◽

Temporal Lobes ◽

Magnetic Resonance Imaging Mri

Structural magnetic resonance imaging (MRI) is a powerful tool to visualize and quantitate morphological and pathological features of the aging brain. Most work that has used structural MRI to study Alzheimer’s disease (AD) focused on the spatial distribution of atrophic changes associated with disease. These studies consistently show focal atrophy beginning in medial temporal lobes in early and presymptomatic stages of AD before spreading globally throughout the cortical mantle. Normal cognitive aging—aging in the absence of major neurodegenerative disease—on the other hand follows and anterior-to-posterior gradient of atrophic change. In addition to atrophic changes, conventional structural MRI can be used to appreciate markers of small and large vessel cerebrovascular disease, including white matter hyperintensities (WMHs), cerebral microbleeds, and infarction. Studies that have examined cerebrovascular changes associated with AD also show a consistent relationship with risk and severity of clinical AD, particularly with regard to lobar microbleeds and posterior WMH. It is unclear whether cerebrovascular changes play an independent role in the clinical expression of AD or whether it is more mechanistically related, reflecting a core feature of the disease. This chapter reviews recent work on regional atrophy in AD and normal aging, as well as work on small and large cerebrovascular disease in AD.

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