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Alzheimer’s disease more likely in patients with cerebral vascular disease
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Results from a cross-sectional study of older adults showed an association between cerebral vascular disease and Alzheimer’s disease.
“Both large and small vessel diseases have effects on dementia and thinking abilities, independently of one another, and independently of the common causes of dementia such as Alzheimer’s pathology and strokes,” Zoe Arvanitakis, MD, MS, neurologist and researcher at Rush Alzheimer’s Disease Center in Chicago, said in a press release. “We found that blood vessel diseases are very common in the brain, and are associated with dementia that is typically attributed to Alzheimer’s disease during life.”
She said although the study does not show a causal relationship, “it does suggest that vessel disease plays a role in dementia.”
Arvanitakis and colleagues analyzed 1,143 adults aged at least 65 years who had yearly clinical assessments and agreed to brain autopsy at death (median age at death, 89 years; 42% with Alzheimer’s disease).
The researchers examined associations between mild, moderate or severe vessel disease (cerebral atherosclerosis or cerebral arteriosclerosis) with probable or possible Alzheimer’s disease and cognitive function.
According to the researchers, 39% of the cohort had moderate to severe atherosclerosis, and 35% had arteriosclerosis.
Increase in level of severity of atherosclerosis or arteriosclerosis was associated with greater odds of Alzheimer’s disease (OR for atherosclerosis = 1.33; 95% CI, 1.11-1.58; OR for arteriosclerosis = 1.2; 95% CI, 1.04-1.4).
The researchers found that atherosclerosis was associated with lower scores for global cognition (estimate, –0.1; standard error, 0.04; P = .0096), episodic memory (estimate, –0.1; standard error, 0.04; P = .017), semantic memory (estimate, –0.11; standard error, 0.05; P = .018), perceptual speed (estimate, –0.14; standard error, 0.04; P = .0008) and visuospatial abilities (estimate, –0.13; standard error, 0.04; P = .008), but not lower scores for working memory (estimate, –0.05; standard error, 0.04; P = .21).
They also found arteriosclerosis was associated with lower scores for global cognition (estimate, –0.1; standard error, 0.03; P = .0015), episodic memory (estimate, –0.12; standard error, 0.04; P = .0009), semantic memory (estimate, –0.1; standard error, 0.04; P = .013), working memory (estimate, –0.07; standard error, 0.03; P = .045) and perceptual speed (estimate, –0.12; standard error, 0.04; P = .0012), and a nonsignificant lower score for visuospatial abilities (estimate, –0.07; standard error, 0.03; P = .052).
Controlling for vascular risk factors or the presence of a variant of the apolipoprotein E epsilon 4 allele did not change the results.
In a related editorial, Peter T. Nelson, MD, PhD, from the University of Kentucky, Lexington, wrote that the study “underscores that cerebrovascular pathology is both impactful and heterogeneous.”
Taken in combination with previous findings, “these results suggest that the aged brain is complex and we should resist the temptation to ration diagnoses, or to develop overly simplistic hypotheses that mostly ignore the pathogenetic complexity,” Nelson wrote. “These mistakes have consequences.” – by Erik Swain
Disclosure: One researcher reports receiving personal fees from Avid Radiopharmaceuticals and Navidea Biopharmaceuticals. Nelson reports no relevant financial disclosures.
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