Abstract
Acetazolamide vasoreactive test measures the increment of cerebral blood flow caused
by compensatory vasodilatation ability of cerebral vessels which can be detected by
transcranial Doppler ultrasound (TCD). This study aimed to compare the vascular reactivity
in patients with vascular dementia (VaD) and Alzheimer's disease (AD).
Patients and methods
AD and VaD patients were recruited from the King Chulalongkorn Hospital Dementia Clinic.
Thai Mini-mental State Examination was used for dementia detection. AD and possible
VaD were defined by NINCDS/ADRDA and NINDS-AIREN criteria. Patients with extracranial
carotid artery stenosis >50% and intracranial artery stenosis were excluded. TCD examination was performed
using DWL Multi Dop-T. TCD was performed on MCA with insonation depth between 45 and
60 mm. Baseline end diastolic velocity (EDV), mid systolic velocity (MSV) and peak
systolic velocity (PSV) were recorded. The velocities were obtained at 2, 5, 10 and
20 min after acetazolamide (1000 mg) injection. Mean baseline velocities (Vo) and
velocities after acetazolamide injection (Va) were compared. Percentage of mean increment
velocities was calculated {[(Va−Vo)/Vo]×100%}. Percentage differences of mean velocity change from Vo to Va at each recorded
minute were compared. SPSS for Windows version 11.5.0. was used.
Result
Nine AD (5 males) and 9 VaD (6 males) were selected. Average ages of VaD and AD groups
were 66.11 years-old and 75.22 years-old respectively. Mini-mental State Examination
(MMSE) score in VaD and AD were 21.13 and 19.00. Mean baseline EDV and MSV in VaD
were higher than AD but mean PSV was lower. The percentage of velocity change after
acetazolamide in AD was higher than VaD at 5, 10 and 20 min. However the differences
were not statistically significant.
Conclusion
Acetazolamide vasoreactive test using TCD may be the additional criterion to differentiate
VaD from AD. Further study with more number of subjects for the study or higher dose
of acetazolamide may be needed to reveal the significant difference of vasoreactive
response between VaD and AD patients.
Keywords
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References
- The incidence of vascular dementia in Canada: a comparison with Europe and East Asia.Neuroepidemiology. 2001; 20: 179-187
- Frequency of early and late-onset dementias in a Japanese memory disorders clinic.Eur J Neurol. 2005; 12: 782-790
- Clinical and hemodynamic aspects of low-flow infarcts.Stroke. 1991; 22: 1117-1123
- Evaluation of cerebral vasoreactivity by SPECT and transcranial Doppler sonography using the acetazolamide test.Nuklearmedizin. 1994; 33: 239-243
- Positron emission tomography and its application to the study of cerebrovascular disease in man.Stroke. 1985; 16: 361-376
- Haemodynamic pathophysiology underlying vascular dementia.J of Clin Neurosci. 2004; 11: 42
- Acetazolamide vasoreactivity in vascular dementia: a positron emission tomographic study.Eur Neurol. 1999; 41: 31-36
- Evaluation of the acetazolamide test. Vasoreactivity and cerebral blood volume.Stroke. 1995; 26: 1234-1239
- Vasomotor reactivity and pattern of collateral blood flow in severe occlusive carotid artery disease.Stroke. 1996; 27: 296-299
- Assessment of cerebral vasomotor reactivity by transcranial Doppler ultrasound and breath-holding. A comparison with acetazolamide as vasodilatory stimulus.Stroke. 1995; 26: 96-100
- TCD and the Diamox test for testing vasomotor reactivity: clinical significance.Neurol Neurochir Pol. 2001; 35: 51-56
- Is impaired cerebral vasomotor reactivity a predictive factor of stroke in asymptomatic patients?.Stroke. 1996; 27: 2188-2190
- Cerebral vasoreactivity in senile dementia.Gerontology. 1977; 23: 148-160
- Acetazolamide vasoreactivity in persistent vegetative state and vascular dementia evaluated by transcranial harmonic perfusion imaging and Doppler sonography.Acta Neurochir Suppl. 2003; 87: 63-69
- Cerebrovascular responsiveness to hypercapnia in Alzheimer's dementia and vascular dementia of the Binswanger type.Stroke. 1992; 23: 594-598
- Regional cerebral blood flow single-photon emission tomography with 99mTc-HMPAO and the acetazolamide test in the evaluation of vascular and Alzheimer's dementia.Eur J Nucl Med. 1999; 26: 239-245
- Reliability and validity of NINCDS-ADRDA criteria for Alzheimer's disease. The National Institute of Mental Health Genetics Initiative.Arch Neurol. 1994; 51: 1198-1204
- Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop.Neurology. 1993; 43: 250-260
- Efficacy study of galantamine in possible Alzheimer's disease with or without cerebrovascular disease and vascular dementia in Thai patients: a slow-titration regimen.Int J Clin Pract. 2006; 60: 533-540
- Neurovascular mechanisms of Alzheimer's neurodegeneration.Trends Neurosci. 2005; 28: 202-208
- Cerebrovascular reactivity in degenerative and vascular dementia: a transcranial Doppler study.Eur Neurol. 2007; 58: 84-89
Article info
Publication history
Published online: April 17, 2009
Identification
Copyright
© 2009 Published by Elsevier Inc.
