Abstract
The critical question as to the respective role of Alzheimer's disease (AD) and cerebrovascular
disease in dementia of the Alzheimer's type (DAT), the most common form of dementia,
is still debated. But there has been considerable progress in understanding cerebral
hemodynamics and the relationship between structural brain damage and cognitive decline,
in routine neuro imaging techniques. These advances now allow the proposition of a
novel MR classification of DAT including indicators of both cerebrovascular function
and regional brain atrophy. MR indicators of windkessel function include the arterial
pulsatility index, the intracranial blood stroke volume, the cerebral relative venous
outflow rates and a relative index of craniospinal compliance. MR indicators of vascular
conduct function include total arterial and superficial venous flow rates that are
closely related to brain metabolism. Structural MR sequences allow the detection of
structural markers of windkessel dysfunction and, beyond the non specific hippocampal
atrophy, a more extensive AD-like MR pattern of atrophy. The first illustration of
this MR classification in elderly patients that later progressed to dementia converges
with recent neuropathological observations to suggest that the major enemy to combat
in late-life dementia is not AD but cerebrovascular dysfunction.
Keywords
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Article info
Publication history
Published online: March 09, 2009
Footnotes
☆Grants: from the French ministry of Health (Programme Hospitalier de Recherche Clinique AOM98053 “Apport de technologies récentes d’exploration cérébrale par résonance magnétique dans le diagnostic précoce de la maladie d'Alzheimer” principal investigator MC Henry-Feugeas).
Identification
Copyright
© 2009 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
