Abstract
The in vivo diagnosis of Alzheimer's disease (AD) may be facilitated by cerebro-spinal fluid
(CSF) biomarkers in combination with imaging and clinical assessments. By determining
the concentration of beta amyloid fragments, total tau (t-tau) and phospho-tau (p-tau),
it is possible to detect the conversion of mild cognitive impairment (MCI) to AD or
distinguish AD vs. pseudo-dementia. However, these markers are poorly sensitive to
the progressive disease stages. And far from clear is their role in “mixed” forms
of dementia, as far as hemodynamic deficits complicate the clinical history.
We have studied cerebral hemodynamic impairment in AD patients, relative to control
subjects. Mean flow velocity (MFV), pulsatility index (PI) and cerebrovascular reactivity
(assayed as breath-holding index, BHI) were evaluated by bilateral transcranial Doppler
(TCD) monitoring of middle cerebral arteries. MFV and BHI were significantly lower
and PI was significantly higher in AD patients with respect to control subjects. The
presence of white-matter changes (WMC) in the AD cases did not influence any of the
hemodynamic variables. Noticeably, MMSE score was correlated to BHI reduction (P<0.005).
Our results, consistent with the recent literature indicate that hemodynamic impairment
is a critical marker of cognitive decline and supports once more the hypothesis of
a significant pathigenic role of vascular damage in AD. Similar functional alterations
might be early hallmarks in a variety of dementia subtypes, including "mixed" dementia,
whose prevalence is undoubtedly increased.
Assessment of hemodynamic reactivity could provide valuable correlations with individual
patient's cognitive profile, which in turn would assist in the identification of critical
steps in disease progression and the validation of effective therapies.
Keywords
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Article info
Publication history
Published online: March 12, 2009
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© 2009 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
