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Review
. 2016 May;1862(5):952-6.
doi: 10.1016/j.bbadis.2015.09.013. Epub 2015 Sep 25.

The role of cerebrovascular disease when there is concomitant Alzheimer disease

Affiliations
Review

The role of cerebrovascular disease when there is concomitant Alzheimer disease

Prashanthi Vemuri et al. Biochim Biophys Acta. 2016 May.

Abstract

Cerebrovascular Pathologies (CVP) are the most common co-existent pathologies observed in conjunction with Alzheimer disease. CVP rarely exists in isolation in later life, and CVP most likely plays a supporting role, rather than a sole leading role, in the pathogenesis of dementia. Our goal is to illustrate CVP's role using neuroimaging biomarkers. First, we discuss the frequency of CVP and present data from population-based Mayo Clinic Study of Aging. Here, we used a novel metric for identifying individuals with cerebrovascular imaging abnormalities (that we designate as "V+") and present the frequency of V-/V+ in the context of absence and presence of β-amyloid elevation (designated A-/A+). Next, we discuss the contribution of CVP to neurodegeneration and use hippocampal volume loss over time in a subset of participants categorized as A-V-, A-V+, A+V-, A+V+. Lastly, we discuss the contribution of CVP to cognitive impairment and conclude with the considerations for design of future studies. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.

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Conflict of interest statement

Disclosure: The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Illustration of the extent and distribution of white matter hyperintensities on a FLAIR MRI observed in an 80 year old female at the cutpoint of 1.1 % WMH of TIV. From a figure shown in.
Figure 2
Figure 2
Prevalence of Amyloid positivity (A+) and Vascular Positivity (V+) in cognitively normal elderly.
Figure 3
Figure 3
Slopes of Hippocampal volume on serial MR scans seen in cognitively normal individuals classified by amyloid and vascular positivity and negativity at baseline. Note that the mean values are all negative indicating some loss in all 4 groups. Subjects with A+V− and A+V+ had significantly greater decline in hippocampal volume in comparison to both the A−V− and AV+ groups.
Figure 4
Figure 4
Typical cognitive decline trajectories that may be expected in pure vs. multi-etiology dementias as a function of time. Panel A illustrates trajectories when the evolution of CVP and ADP are nearly at the same time. Panel B illustrates trajectories when CVP starts at a later time after the onset of ADP. Panel C illustrates trajectory where the event of a single strategic infarct (pure CVP) is followed shortly by the onset of ADP. The threshold shown in the figure indicates the cognitive threshold for dementia detection.

References

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