Treatment of vascular risk factors in patients with a diagnosis of Alzheimer’s disease: a systematic review

Abstract

BackgroundIncreasing evidence suggests vascular risk factors (VRF) play a role in the pathogenesis of Alzheimer’s disease (AD). Epidemiological studies have found associations between VRF and risk of AD. Treating VRF in patients with AD offers a potential treatment option but ineffective treatments should be avoided in this group who are frequently on multiple medications and in whom compliance may be challenging.MethodsStudies containing information on the treatment of VRF in patients with a diagnosis of AD were identified using a defined search strategy. Randomised controlled trials and observational studies were included.ResultsThe pre-specified search strategy retrieved 11,992 abstract articles, and 25 papers including those identified on review of reference lists and reviews met the inclusion criteria. Of these, 11 were randomised controlled trials (RCTs) and 14 observational studies. Observational studies suggested that a VRF package and treatment of hypertension and statin therapy may be associated with improved outcome but these studies suffered from potential bias. The few RCTs performed were mostly small with short duration follow-up, and do not provide clear evidence either way.ConclusionsObservational data raises the possibility that treating VRF could alter the rate of decline in AD. However RCT data are not yet available to support this hypothesis and to alter clinical practice. RCTs in larger numbers of individuals with longer follow-up, ideally in the early stages of AD, are required to address this potentially important treatment question.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0160-z) contains supplementary material, which is available to authorized users.

Atrial Fibrillation and Cognition

“…39 This implies that treating AF could have an impact on disease progression in patients with dementia. 35 The effects of anticoagulation on cognitive outcomes has rarely been investigated. One recent study proved that among 2605 AF patients treated with warfarin, the quality of anticoagulation, expressed in terms of time in the therapeutic range, was indeed associated with incident dementia.…”

“…34 Last, but not least, AF and dementia share common risk factors, and these same risk factors seem to play an important role in by guest on May 11, 2018 http://stroke.ahajournals.org/ Downloaded from the progression of cognitive impairment, from mild cognitive impairment to dementia. 3,35,36 Putting all these data together, although the pathophysiological inter-relationships between AF, degenerative and vascular dementia are still not elucidated, endothelial dysfunction might represent the possible common denominator, and this hypothesis warrants further investigation.…”

The neuropathology and cerebrovascular mechanisms of dementia

“…Treatments aimed at reducing vascular risk factors, such as better blood pressure control, improved diet, and exercise have been shown to improve disease incidence and progression. 17 The brain histopathology and pathophysiology may not necessarily reflect clinical symptoms. The disease(s) may take years to manifest their cognitive, behavioral, and functional impairments.…”

Role of Vascular Disease in Alzheimer-Like Progressive Cognitive Impairment

“…Until disease-modifying AD treatments are identified (a day that cannot possibly come too soon), this translates to treatment of vascular risk factors. Whether this approach can slow cognitive decline in patients with symptomatic dementia remains unclear, 27 but recent reports of improved cognitive performance in a randomized trial of at-risk cognitively normal individuals 28 and falling age-specific dementia prevalence in population-based observational studies 8 suggest small (and surprisingly uncelebrated) victories in the ongoing battle against age-related dementia. I join my co-authors in encouraging readers to think critically and act decisively in evaluating and treating the vascular contribution to their patients’ cognition.…”