Alzheimer's, Dementia & Mental Health
Early Vascular Disease Therapy May Delay or Prevent
Dementia Due to Alzheimer’s, Parkinson’s
In a variety of neurodegenerative diseases,
cerebrovascular disease affecting circulation of blood in the brain was
significantly associated with dementia
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Link with vascular disease
was strongest with Alzheimer's disease |
July 15, 2013 - The early management of vascular
risk factors, such as high blood pressure and cholesterol, and adopting
a 'heart healthy' diet as well as exercise and other lifestyles in
midlife may delay or prevent the onset of dementia due to Alzheimer's
and Parkinson's disease, suggests a recent study by researchers in the
Perelman School of Medicine at the University of Pennsylvania.
They found that across a variety of
neurodegenerative diseases, cerebrovascular disease affecting
circulation of blood in the brain was significantly associated with
dementia. The researchers contend that people already exhibiting
clinical features of Alzheimer's disease and other memory impairments
may benefit from effective therapies currently available to reduce
vascular problems.
The link between cerebrovascular disease was
strongest with Alzheimer's disease – as compared to other
neurodegenerative diseases including frontotemporal lobar degeneration,
Lou Gehrig’s disease or ALS and Parkinson's disease. It also had the most
pronounced effect in younger Alzheimer's patients, according to the
study, published in the July 10 issue of Brain.
"While there was evidence already to suggest that
vascular disease could play a role in neurodegenerative disease, this is
the first study to compare the burden of vascular disease across
neurodegenerative diseases with multiple, distinct or different
origins," said senior author
John Q. Trojanowski, MD, PhD,
director of the National Institute on Aging-funded Alzheimer's Disease
Core Center at the University of Pennsylvania and professor of
Pathology and Laboratory Medicine.
"We were surprised to find such a strong link to
vascular disease in Alzheimer's disease, especially in younger patients,
in comparison to individuals with other neurodegenerative diseases."
Penn researchers analyzed 5,715 cases from the
National Alzheimer's Coordinating Center (NACC) database, which have
been collected from 35 past and present NIA-funded Alzheimer’s centers
across the US since NACC was started in 1999. This is the first study to
compare the presence of cerebrovascular disease across the whole
spectrum of neurogenerative diseases.
Nearly 80 percent of the more than 4,600
Alzheimer's disease patients showed some degree of vascular pathology –
defined as hardened or blocked blood vessels, tissue death due to lack
of blood supply, or bleeding – in the brain, as compared to 67 percent
in the control group of people with no remarkable brain disease
pathology, and 66 percent in the Parkinson's pathology group.
"In the absence of any disease modifying therapies
to change the course of the Alzheimer’s and Parkinson’s, we hope that
the diligent use of existing treatments for vascular conditions and the
implementation of campaigns promoting healthy lifestyles in young and
middle aged people may have a positive impact on preventing or reducing
dementia symptoms in Alzheimer’s and Parkinson’s disease " said lead
study author Jon B. Toledo, MD, postdoctoral researcher at the
University of Pennsylvania Perelman School of Medicine.
The study has implications from a public health
perspective and for the design of clinical study cohorts that better
represent the general population of people with cognitive impairment. In
addition, drugs tested for Alzheimer's disease and other related
dementias should consider the impact of the frequent concident presence
of cerebrovascular disease on the treatment response of new therapies
for Alzheimer’s, as most current trials exclude patients with vascular
risk factors or cardiovascular disease. Given the prevalence of vascular
problems, the researchers note that this large subset of dementia
patients should be included in clinical trials to accurately represent
the true population dealing with these neurodegenerative diseases, or,
at least considered when predicting the clinical impact on patients in a
real world population.
Additional members of the Penn study team include
Steven Arnold, MD, co-director of Penn's Alzheimer's Disease Core Center
and Murray Grossman, MD, EdD, director of the Penn Frontotemporal
Disease Center; Kevin Raible and Johanness Brettschneider from the
Center for Neurodegenerative Disease Research; and Sharon Xie, from the
Department of Biostatics and Epidemiology. Colleagues at the National
Alzheimer's Coordinating Center at the University of Washington also
contributed to this report.
Funding was provided by the National Institute on
Aging (U01 AG016976 and P30 AG010124), with additional support from the
Fundacion Alfonso Martin Escudero.
Related Links
Center for Neurodegenerative Disease
Research
Perelman School of Medicine at the
University of Pennsylvania
University of Pennsylvania Health
System
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