Treatment of vascular risk factors is associated with slower decline in Alzheimer disease

Deschaintre, Yan; Richard, Florence; Leys, Didier; Pasquier, Florence

doi:10.1212/wnl.0b013e3181b59bf3

Cited by 215 publications

(153 citation statements)

References 42 publications

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“…In addition, several epidemiologic studies have shown that vascular risk factors such as arterial hypertension and hypercholesterolemia also contribute to the progression of AD (Helzner et al, 2009;Roselli et al, 2009). Moreover, treatment of vascular risk factors has been associated with reduced risk of developing AD (Forette et al, 2002) and with a slower cognitive decline in AD patients (Deschaintre et al, 2009). In accordance with these findings, the amount of cerebrovascular degeneration with consecutive hypoperfusion of the brain seems to influence clinical manifestation and severity of cognitive decline in AD patients.…”

Section: Introductionmentioning

confidence: 76%

Predictive Value of Platelet Activation for the Rate of Cognitive Decline in Alzheimer's Disease Patients

Stellos

Panagiota

Kögel³

et al. 2010

J Cereb Blood Flow Metab

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Vascular risk factors contribute to the progression of dementia in Alzheimer's disease (AD) and influence platelet activation. However, the degree of platelet activation as a possible underlying mechanism of this progression has not been studied till now. Significantly higher baseline expression of both platelet activation biomarkers, activated glycoprotein IIb-IIIa complex and P-selectin, was observed in patients with AD with fast cognitive decline compared with AD patients with slow cognitive decline during a 1-year follow-up period. These results suggest that platelet activation could be a putative prognostic biomarker for the rate of cognitive decline and a potential new treatment target in AD patients.

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Section: Introductionmentioning

confidence: 76%

Predictive Value of Platelet Activation for the Rate of Cognitive Decline in Alzheimer's Disease Patients

Stellos

Panagiota

Kögel³

et al. 2010

J Cereb Blood Flow Metab

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“…10,57 Improving equity of access to good quality medical care is underpinned by, for example, the Care Quality Commission, 58 Healthcare Improvement Scotland, 59 and the National Dementia Strategies for England 60 and Scotland. 61 Educational interventions developed for general practices may be one potential strategy, as they have already been shown to improve detection of dementia, 62 and trials are underway to improve overall clinical management and adherence to management guidelines.…”

mentioning

confidence: 99%

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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BackgroundVascular diseases contribute to the causation and progression of clinical dementia. AimTo evaluate the quality of medical care for vascular diseases provided to people with dementia, the patient and practice characteristics that influence quality, and to compare care with that provided to those without dementia. Design and settingObservational, cross-sectional review of primary care records of people with dementia from 52 general practices from five primary care trusts in the UK, and comparison with publicly available summary data on patients without dementia. MethodA total of 700 patients with ≥1 diagnosed vascular disease or risk factor were identified from dementia registers. Quality of care was measured on 30 indicators from the UK Quality and Outcomes Framework (QOF) for hypertension, coronary heart disease, stroke, diabetes mellitus, atrial fibrillation, heart failure, and smoking. Overall quality of vascular care was calculated for each patient with dementia. ResultsLevel of care received by people with dementia was significantly lower compared with those without dementia for 22 of 30 (73%) indicators; most notably for measurement processes such as peripheral pulses check and neuropathy testing for diabetes, and cholesterol measures for stroke. Among people with dementia, women, those in care homes, and those with fewer comorbid physical conditions and medications were associated with lower scores for overall quality of vascular care. ConclusionThe quality of medical care provided to people with dementia with regard to vascular diseases is not concordant with quality, as defined by the QOF. Research is needed to improve access to high-quality care.

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“…Combined treatment of multiple CV risk factors can slow the progression of MRI lesions, 16 but cognitive outcomes have shown mixed results. 17,18 APOE 4 is a proven genetic risk factor for AD 19 and memory declines more quickly in APOE 4 carriers than noncarriers beginning around age 55-60 years as a preclinical harbinger of impending mild cognitive impairment (MCI) and dementia. 20 CV risk factors further influence the effect of APOE 4 carrier status on cognitive decline in elderly individuals, 21 but their interaction with APOE 4 gene dose might underlie inconsistent therapeutic outcomes.…”

mentioning

confidence: 99%

Cerebrovascular risk factors and preclinical memory decline in healthy APOE ε4 homozygotes

Caselli¹,

Dueck²,

Locke³

et al. 2011

Neurology

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Objective: To characterize the effects of cerebrovascular (CV) risk factors on preclinical memory decline in cognitively normal individuals at 3 levels of genetic risk for Alzheimer disease (AD) based on APOE genotype. Methods:We performed longitudinal neuropsychological testing on an APOE 4 enriched cohort, ages 21-97. The long-term memory (LTM) score of the Auditory Verbal Learning Test (AVLT) was the primary outcome measure. Any of 4 CV risk factors (CVany), including hypercholesterolemia (CHOL), prior cigarette use (CIG), diabetes mellitus (DM), and hypertension (HTN), was treated as a dichotomized variable. We estimated the longitudinal effect of age using statistical models that simultaneously modeled the cross-sectional and longitudinal effects of age on AVLT LTM by APOE genotype, CVany, and the interaction between the two.Results: A total of 74 APOE 4 homozygotes (HMZ), 239 4 heterozygotes (HTZ), and 494 4 noncarriers were included. APOE 4 carrier status showed a significant quadratic effect with age-related LTM decline in all models as previously reported. CVany was associated with further longitudinal AVLT LTM decline in APOE 4 carriers (p ϭ 0.02), but had no effect in noncarriers. When 4 HTZ and HMZ were considered separately, there was a striking effect in HMZ (p Ͻ 0.001) but not in HTZ. In exploratory analyses, significant deleterious effects were found for CIG (p ϭ 0.001), DM (p ϭ 0.03), and HTN (p ϭ 0.05) in APOE 4 carriers only that remained significant only for CIG after correction for multiple comparisons. Conclusion: CV risk factors influence age-related memory decline in APOE 4 HMZ. Neurology

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Treatment of vascular risk factors is associated with slower decline in Alzheimer disease

Cited by 215 publications

References 42 publications

Predictive Value of Platelet Activation for the Rate of Cognitive Decline in Alzheimer's Disease Patients

Predictive Value of Platelet Activation for the Rate of Cognitive Decline in Alzheimer's Disease Patients

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Cerebrovascular risk factors and preclinical memory decline in healthy APOE ε4 homozygotes

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