The acetylcholine (ACh) and choline (Ch) concentrations in the cerebrospinal fluid were investigated in patients with vascular dementia of the Binswanger type (VDBT) or multiple small infarct type (MSID) as compared with patients with Alzheimer-type dementia (ATD). The ACh concentration in patients with ATD was found to be significantly lower than in controls (73%, p < 0.0001), and showed a significant positive correlation with dementia scale scores (rs = 0.63, p < 0.03). The Ch concentration in the CSF of ATD patients was approximately the same as in controls. In VDBT/MSID patients, the ACh concentration was significantly lower than in controls (p < 0.001) also showing a significant positive correlation with dementia scale scores (rs = 0.62, p < 0.02), but was significantly higher than in ATD patients (p < 0.001). Moreover, the Ch concentration in VDBT/MSID patients was significantly higher than in controls (p < 0.001) or ATD patients (p < 0.001). These results suggest that simultaneous determination of ACh and Ch concentrations in CSF may be useful for differentiating VDBT/MSID from ATD and that increasing the ACh level using cholinergic agents may be a beneficial therapeutic strategy for the treatment of ATD as well as VDBT/MSIT, and is worthy of further investigation.

Using a noninvasive portable blood pressure recorder, we compared 24-hour variations of blood pressure among 1) 35 patients with Binswanger-type dementia, 2) 43 with lacunar-type dementia, 3) 26 with a single lacunar stroke, and 4) 30 controls. Each group was divided into antihypertensive-treated and -untreated subgroups. Among the untreated subgroups, patients with Binswanger-type dementia had significantly greater 24-hour mean systolic blood pressures, 24-hour systolic blood pressure standard deviations, and maximal systolic blood pressure variations than the controls (p<0.05). Among the treated patients, blood pressure variability increased similarly in all subgroups with cerebrovascular lesions compared with the controls (p<0.05). The nocturnal blood pressure decreases seen in the controls were absent among both untreated and treated patients with Binswanger-or lacunar-type dementia (/7<0.05). Our results suggest the importance of hypertension, short-term variations in blood pressure, and a sustained nighttime elevation of blood pressure for the pathogenesis of both Binswanger-type and lacunar-type dementia in patients receiving antihypertensive medication. (Stroke 1991^22:603-608) V ascular dementia of the Binswanger type, also termed subcortical arteriosclerotic encephalopathy, is characterized pathologically by diffuse white matter changes and multiple small infarcts in the cerebral white matter.1 -9 Although there has been some debate concerning this disease entity, it is now generally accepted that vascular dementia of the Binswanger type is part of the spectrum of cerebrovascular disease that occurs largely as a result of hypertensive changes in the walls of small penetrating arteries. 10Because the cerebral white matter is located in the end-fields of penetrating arteries, its metabolism may be impaired by wide fluctuations in blood pressure, particularly if cerebrovascular autoregulation is impaired. Previous reports have indicated that patients with impaired blood pressure regulation such as hypertension, labile systolic pressure, and orthostatic hypotension are at high risk for developing Binswanger-type dementia. Received November 7, 1990; accepted February 5, 1991. pressure changes and how low it may fall during the day. Moreover, it remains to be determined whether the significance of such blood pressure abnormalities is the same in the pathogenesis of single lacunar stroke or lacunar states not associated with diffuse white matter changes such as in Binswanger-type dementia.However, it has been demonstrated that ambulatory blood pressure readings correlate more closely with target-organ damage than casual blood pressure readings. 11 -14 Therefore, using a noninvasive portable blood pressure recorder, we compared 24-hour variations in the blood pressure of patients with lacunartype dementia, Binswanger-type dementia, a single lacunar stroke, and controls. Subjects and MethodsThe 134 subjects comprised four groups: 1) 30 controls (mean±SD age 69 ±10 years) with minor neurological or nonneurolo...

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We studied changes in the concentrations of serotonin (5-HT), kynurenine, and other indoleamines in the cerebrospinal fluid of patients with Alzheimer type dementia (ATD) and those with Binswanger type vascular dementia (VDBT), and changes in these indoleamine concentrations 2 weeks after administration of citalopram, a 5-HT uptake inhibitor. The concentrations of total 5-HT (p < 0.005) and kynurenine (p < 0.005) were significantly decreased in ATD patients in comparison to those of the controls. After citalopram administration, there was a remarkable increase in 5-HT concentration (249%, p < 0.0001) and a significant decrease in 5-HIAA concentration (22%, p < 0.02). In the VDBT patients, only 5-HT showed a significant decrease (p < 0.005) in comparison to the control values. It also increased significantly (214%) after citalopram administration. The 5-HT/tryptophan and kynurenine/tryptophan ratios were not correlated for the controls, but did significantly for the ATD and VDBT patients; after citalopram treatment, the increase in 5-HT/tryptophan was correlated significantly with that of kynurenine/tryptophan for ATD, but not for VDBT. These results suggest that both the serotonin and kynurenine pathways are impaired in ATD; whereas, the serotonin pathway alone is in VDBT, and that these impairments are ameliorated by the administration of citalopram.