Association between vascular comorbidity and progression of Alzheimer’s disease: a two-year observational study in Norwegian memory clinics

Eldholm, Rannveig Sakshaug; Persson, Karin; Barca, Maria Lage; Knapskog, Anne Brita; Cavallin, Lena; Engedal, Knut; Selbæk, Geir; Skovlund, Eva; Saltvedt, Ingvild

doi:10.1186/s12877-018-0813-4

Cited by 30 publications

(29 citation statements)

References 47 publications

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“…This means that of those patients who developed dementia, 77.2% had obtained a result below the cut-off point, compared to 41.4% in those who did not develop the disease, which is very similar to our results (see Table 5). In addition, they observed that the dif- This result is in line with other studies which did not find this association either in MCI patients [20] [38].…”

Section: Discussionsupporting

confidence: 87%

Longitudinal Follow-Up of a Population with MCI: Predictive Value of the MIS Test with Delayed Recall for Progression to Dementia

Edith¹,

Cavagna²,

Luis³

et al. 2018

AAD

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Background: Early detection of dementia is currently of great interest and of crucial importance for the implementation of preventive measures and treatment of the disease. Impairment in verbal episodic memory, and in particular in a delayed recall phase, is considered one of the early markers of progression from mild cognitive impairment (MCI) to dementia. Therefore, having cognitive screening instruments with predictive value for progression is of utmost importance. Objective: The purpose of this work is to show the predictive value, sensitivity and specificity of the Memory Impairment Screen with delayed recall (MIS-DR) to predict conversion to dementia in patients with MCI. Methods: In retrospective study 502 patients over 60 years old, evaluated in the Older Adult Functional Evaluation Unit of our hospital for cognitive complaint, were diagnosed with MCI. They were followed up to assess conversion to dementia. Results: During follow up, 144 participants developed dementia (28.6%, 95% CI 24.76-32.85) and the average time of progression to dementia were 23 months (SD 13.2). The cutoff point was established below 6 for MIS-DR and it showed a sensitivity of 76% (95% CI 68.77-77.84) and a specificity of 56% (95% CI 50.44-61.58), with a positive predictive value of 41% (95% CI 34.78-47.6) and a negative predictive value of 85% (95% CI 80.53-91.11) for predicting progression to dementia. Of those patients who obtained a MIS-DR score below 6, 41% developed dementia, in contrast to 14.53% of those with a score above or equal to 6, OR 4.09 (95% CI 2.64-6.34), p < 0.00001. There were no significant differences in terms of gender, education level or vascular risk factors among patients who converted and those who did not convert to dementia. Conclusion: We believe that MIS-DR is a useful and valid test to detect episodic memory impairment and to identify patients at risk of progression to dementia.

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Section: Discussionsupporting

confidence: 87%

Longitudinal Follow-Up of a Population with MCI: Predictive Value of the MIS Test with Delayed Recall for Progression to Dementia

Edith¹,

Cavagna²,

Luis³

et al. 2018

AAD

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“…In our study, the group of AD patients not classified with CVD may also have had some CVD, as many of them had some degree of WMH on MRI (Fazekas score of 1) and most had vascular risk factors (35).…”

Section: Discussionmentioning

confidence: 72%

Symptom profiles in patients with Alzheimer’s disease with and without concomitant cerebrovascular disease: an observational study

Eldholm

Barca²,

Persson

et al. 2019

Preprint

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Background: Diagnostic criteria of Alzheimer’s disease (AD) and vascular cognitive impairment (VCI) describe different cognitive profiles. AD patients often have concomitant cerebrovascular disease (CVD) and these patients could therefore be expected to display symptoms of both AD and VCI. AD patients with concomitant CVD display symptoms of cognitive impairment with less AD pathology than those without CVD. Medial temporal atrophy (MTA) on magnetic resonance imaging (MRI) is a biomarker of neurodegeneration in AD, and we would expect less MTA in AD patients with CVD. The first aim was to examine whether there were differences in the results of cognitive tests for memory, executive function, and processing speed, or in depressive symptoms, between AD patients with and without CVD. Secondly, to assess whether MTA on MRI is more pronounced among AD patients without CVD. Methods: A total of 192 AD patients with amnestic mild cognitive impairment or mild dementia underwent cognitive assessment and depression screening. Cerebral MRIs were assessed for MTA, white matter hyperintensities, and lacunar and cortical infarcts. CVD was defined as the presence of white matter hyperintensities Fazekas scale ≥2 or any infarct. To study the effect of CVD, several multiple linear regression analyses were carried out using CVD adjusted for age and sex as the independent variable, and cognitive test scores, depression scores, and MTA as dependent variables. Results: Mean age was 72.2 (SD 8.3) years. The number of AD patients with and without concomitant CVD was 121 and 71, respectively. The group with CVD scored significantly lower on tests of attention, executive function and immediate recall compared with the group without CVD. In analyses controlled for age and sex, concomitant CVD was not associated with significant differences in any cognitive test nor in depressive symptoms. A statistically significant association between AD with concomitant CVD and more pronounced MTA was identified. Conclusions: The results indicate that cognitive test profiles, depressive symptoms, and MTA scores cannot be used to distinguish AD patients with and without CVD.

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“…Cardiovascular disorders are very common in patients with AD. Up to 83% of these patients have arterial hypertension and 16% have ischemic heart disease, whereas 15% of them have suffered a cerebrovascular event [ 39 ]. Another study found a prevalence of 55.1% for arterial hypertension and 22.7% for cerebrovascular disease [ 40 ].…”

Section: Dysautonomia As a Results Of Comorbidities And Medicationmentioning

confidence: 99%

“…Another major comorbidity in the elderly is diabetes mellitus, with a prevalence of 9–25.7% [ 39 , 40 ]. Diabetes mellitus is regarded as a common cause of neuropathy-associated autonomic dysfunction.…”

Section: Dysautonomia As a Results Of Comorbidities And Medicationmentioning

confidence: 99%

Dysautonomia in Alzheimer's Disease

et al. 2020

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Alzheimer's disease is the most common neurodegenerative disorder, and its prevalence increases with age. Although there is a large amount of scientific literature focusing on Alzheimer's disease cardinal cognitive features, autonomic nervous system dysfunction remains understudied despite being common in the elderly. In this article, we reviewed the evidence for autonomic nervous system involvement in Alzheimer's disease. We identified four major potential causes for dysautonomia in Alzheimer's disease, out of which two are well-studied (comorbidities and medication) and two are rather hypothetical (Alzheimer's pathology and brain co-pathology). Although there appears to be some evidence linking Alzheimer's disease pathology to autonomic nervous system dysfunction, there is an important gap between two types of studies; histopathologic studies do not address dysautonomia manifestations, whereas clinical studies do not employ histopathologic diagnostic confirmation. Moreover, brain co-pathology is emerging as an important confounding factor. Therefore, we consider the correlation between dysautonomia and Alzheimer's disease to be an open question that needs further study. Nevertheless, given its impact on morbidity and mortality, we emphasize the importance of assessing autonomic dysfunction in patients with Alzheimer clinical syndrome.

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Association between vascular comorbidity and progression of Alzheimer’s disease: a two-year observational study in Norwegian memory clinics

Cited by 30 publications

References 47 publications

Longitudinal Follow-Up of a Population with MCI: Predictive Value of the MIS Test with Delayed Recall for Progression to Dementia

Longitudinal Follow-Up of a Population with MCI: Predictive Value of the MIS Test with Delayed Recall for Progression to Dementia

Symptom profiles in patients with Alzheimer’s disease with and without concomitant cerebrovascular disease: an observational study

Dysautonomia in Alzheimer's Disease

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