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     Cardiology Today   
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   IN THE JOURNALS   
   Alzheimer’s disease more likely in patients with cerebral vascular disease   
      
   Arvanitakis Z, et al. Lancet Neurol. 2016;doi:10.1016/S1474-4422(16)30029-1.   
   Nelson PT. Lancet Neurol. 2016;doi:10.1016/S1474-4422(16)30038-2.   
      
   July 29, 2016   
   Results from a cross-sectional study of older adults showed an association   
   between cerebral vascular disease and Alzheimer’s disease.   
      
   “Both large and small vessel diseases have effects on dementia and thinking   
   abilities, independently of one another, and independently of the common   
   causes of dementia such as Alzheimer’s pathology and strokes,” Zoe   
   Arvanitakis, MD, MS, neurologist    
   and researcher at Rush Alzheimer’s Disease Center in Chicago, said in a   
   press release. “We found that blood vessel diseases are very common in the   
   brain, and are associated with dementia that is typically attributed to   
   Alzheimer’s disease during    
   life.”   
      
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   She said although the study does not show a causal relationship, “it does   
   suggest that vessel disease plays a role in dementia.”   
      
   Arvanitakis and colleagues analyzed 1,143 adults aged at least 65 years who   
   had yearly clinical assessments and agreed to brain autopsy at death (median   
   age at death, 89 years; 42% with Alzheimer’s disease).   
      
   The researchers examined associations between mild, moderate or severe vessel   
   disease (cerebral atherosclerosis or cerebral arteriosclerosis) with probable   
   or possible Alzheimer’s disease and cognitive function.   
      
   According to the researchers, 39% of the cohort had moderate to severe   
   atherosclerosis, and 35% had arteriosclerosis.   
      
   Increase in level of severity of atherosclerosis or arteriosclerosis was   
   associated with greater odds of Alzheimer’s disease (OR for atherosclerosis   
   = 1.33; 95% CI, 1.11-1.58; OR for arteriosclerosis = 1.2; 95% CI, 1.04-1.4).   
      
   The researchers found that atherosclerosis was associated with lower scores   
   for global cognition (estimate, –0.1; standard error, 0.04; P = .0096),   
   episodic memory (estimate, –0.1; standard error, 0.04; P = .017), semantic   
   memory (estimate, –0.11;    
   standard error, 0.05; P = .018), perceptual speed (estimate, –0.14; standard   
   error, 0.04; P = .0008) and visuospatial abilities (estimate, –0.13;   
   standard error, 0.04; P = .008), but not lower scores for working memory   
   (estimate, –0.05; standard    
   error, 0.04; P = .21).   
      
   They also found arteriosclerosis was associated with lower scores for global   
   cognition (estimate, –0.1; standard error, 0.03; P = .0015), episodic memory   
   (estimate, –0.12; standard error, 0.04; P = .0009), semantic memory   
   (estimate, –0.1; standard    
   error, 0.04; P = .013), working memory (estimate, –0.07; standard error,   
   0.03; P = .045) and perceptual speed (estimate, –0.12; standard error, 0.04;   
   P = .0012), and a nonsignificant lower score for visuospatial abilities   
   (estimate, –0.07; standard    
   error, 0.03; P = .052).   
      
   Controlling for vascular risk factors or the presence of a variant of the   
   apolipoprotein E epsilon 4 allele did not change the results.   
      
   In a related editorial, Peter T. Nelson, MD, PhD, from the University of   
   Kentucky, Lexington, wrote that the study “underscores that cerebrovascular   
   pathology is both impactful and heterogeneous.”   
      
   Taken in combination with previous findings, “these results suggest that the   
   aged brain is complex and we should resist the temptation to ration diagnoses,   
   or to develop overly simplistic hypotheses that mostly ignore the pathogenetic   
   complexity,”    
   Nelson wrote. “These mistakes have consequences.” – by Erik Swain   
      
   Disclosure: One researcher reports receiving personal fees from Avid   
   Radiopharmaceuticals and Navidea Biopharmaceuticals. Nelson reports no   
   relevant financial disclosures.   
       
      
       
       
             
   See Also   
   Cerebrovascular disease often linked to Alzheimer's disease   
   Lower blood pressure may not reduce risk for Alzheimer's ...   
   Understanding link between vascular disease, dementia ...   
      
      
      
      
      
      
      
      
      
      
   http://www.healio.com/cardiology/stroke/news/online/%7Bbb69ad5f-   
   1f3-4ab9-8e1f-ac77207e2555%7D/alzheimers-disease-more-likely-in-   
   atients-with-cerebral-vascular-disease   
      
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