Research Article| Volume 283, ISSUE 1-2, P32-35, August 15, 2009

Vasoreactivity induced by acetazolamide in patients with vascular dementia versus Alzheimer's disease

Published:April 17, 2009DOI:


      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 {[(VaVo)/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.


      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.


      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.


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        • Dubois M.F.
        • Hebert R.
        The incidence of vascular dementia in Canada: a comparison with Europe and East Asia.
        Neuroepidemiology. 2001; 20: 179-187
        • Yokota O.
        • Sasaki K.
        • Fujisawa Y.
        • Takahashi J.
        • Terada S.
        • Ishihara T.
        • et al.
        Frequency of early and late-onset dementias in a Japanese memory disorders clinic.
        Eur J Neurol. 2005; 12: 782-790
        • Weiller C.
        • Ringelstein E.B.
        • Reiche W.
        • Buell U.
        Clinical and hemodynamic aspects of low-flow infarcts.
        Stroke. 1991; 22: 1117-1123
        • Pavics L.
        • Grunwald F.
        • Barzo P.
        • et al.
        Evaluation of cerebral vasoreactivity by SPECT and transcranial Doppler sonography using the acetazolamide test.
        Nuklearmedizin. 1994; 33: 239-243
        • Powers W.J.
        • Raichle M.E.
        Positron emission tomography and its application to the study of cerebrovascular disease in man.
        Stroke. 1985; 16: 361-376
        • Nagata K.
        Haemodynamic pathophysiology underlying vascular dementia.
        J of Clin Neurosci. 2004; 11: 42
        • De Reuck J.
        • Decoo D.
        • Hasenbroekx M.C.
        • et al.
        Acetazolamide vasoreactivity in vascular dementia: a positron emission tomographic study.
        Eur Neurol. 1999; 41: 31-36
        • Okudaira Y.
        • Bandoh K.
        • Arai H.
        • Sato K.
        Evaluation of the acetazolamide test. Vasoreactivity and cerebral blood volume.
        Stroke. 1995; 26: 1234-1239
        • Muller M.
        • Schimrigk K.
        Vasomotor reactivity and pattern of collateral blood flow in severe occlusive carotid artery disease.
        Stroke. 1996; 27: 296-299
        • Muller M.
        • Voges M.
        • Piepgras U.
        • Schimrigk K.
        Assessment of cerebral vasomotor reactivity by transcranial Doppler ultrasound and breath-holding. A comparison with acetazolamide as vasodilatory stimulus.
        Stroke. 1995; 26: 96-100
        • Gur A.Y.
        • Bornstein N.M.
        TCD and the Diamox test for testing vasomotor reactivity: clinical significance.
        Neurol Neurochir Pol. 2001; 35: 51-56
        • Gur A.Y.
        • Bova I.
        • Bornstein N.M.
        Is impaired cerebral vasomotor reactivity a predictive factor of stroke in asymptomatic patients?.
        Stroke. 1996; 27: 2188-2190
        • Dekoninck W.J.
        • Collard M.
        • Noel G.
        Cerebral vasoreactivity in senile dementia.
        Gerontology. 1977; 23: 148-160
        • Shiogai T.
        • Koshimura M.
        • Uebo C.
        • Makino M.
        • Mizuno T.
        • Nakajima K.
        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
        • Kuwabara Y.
        • Ichiya Y.
        • Otsuka M.
        • Masuda K.
        • Ichimiya A.
        • Fujishima M.
        Cerebrovascular responsiveness to hypercapnia in Alzheimer's dementia and vascular dementia of the Binswanger type.
        Stroke. 1992; 23: 594-598
        • Pavics L.
        • Grunwald F.
        • Reichmann K.
        • Kitschenberg A.
        • Hartmann A.
        • Menzel C.
        • et al.
        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
        • Blacker D.
        • Albert M.S.
        • Bassett S.S.
        • Go R.C.
        • Harrell L.E.
        • Folstein M.F.
        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
        • Roman G.C.
        • Tatemichi T.K.
        • Erkinjuntti T.
        • et al.
        Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop.
        Neurology. 1993; 43: 250-260
        • Thavichachart N.
        • Phanthumchinda K.
        • Chankrachang S.
        • Praditsuwan R.
        • Nidhinandana S.
        • Senanarong V.
        • et al.
        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
        • Zlokovic B.V.
        Neurovascular mechanisms of Alzheimer's neurodegeneration.
        Trends Neurosci. 2005; 28: 202-208
        • Vicenzini E.
        • Ricciardi M.C.
        • Altieri M.
        • Puccinelli F.
        • Bonaffini N.
        • Di Piero V.
        • et al.
        Cerebrovascular reactivity in degenerative and vascular dementia: a transcranial Doppler study.
        Eur Neurol. 2007; 58: 84-89