Abstract
Background
Neuropathology of Alzheimer's disease (AD) demonstrates that the common occurrence
of vascular lesions and vascular factors is suggested to contribute significantly
to the clinical progression of the disease. This study has assessed the presence of
vascular brain lesions and risk factors in subjects with diagnosis of AD and their
influence on the disease course both in Late Onset Dementia (LOD) and in Early Onset
Dementia (EOD).
Methods
MRI scans of 374 LOD and of 67 EOD patients were evaluated for the presence of vascular
associated lesions and rated according to the age-related white matter changes (ARWMC)
scale as “pure degenerative”, “mixed” and “vascular” cases of dementia. Vascular risk
factors burden (hypertension, diabetes, dyslipidemia, myocardial infarction) and disease
progression were also assessed.
Results
44% of LOD cases and 46% of EOD were classified as “mixed dementia cases”. The vascular
risk factors burden showed an increase from the pure degenerative to the pure vascular
forms. Disease progression, calculated in two years using the Mini Mental State Evaluation
(MMSE), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living
(IADL) scores, did not reveal differences among the three different classes of dementias.
Conclusions
Vascular lesions are found in the majority of LOD cases and in about one half of EOD.
This observation is consistent with the hypothesis of a synergistic effect of the
degenerative and vascular factors on the development of cognitive dysfunction. The
linear increase of the vascular burden supports the idea of a continuum spectrum between
the pure degenerative and the pure vascular forms of adult-onset dementia disorders.
Keywords
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Article info
Publication history
Published online: September 10, 2012
Accepted:
July 27,
2012
Received in revised form:
July 19,
2012
Received:
February 20,
2012
Identification
Copyright
© 2012 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
