Similarities between Alzheimer's disease and vascular dementia

doi:10.1016/S0022-510X(02)00256-3

Journal of the Neurological Sciences

Volumes 203–204, 15 November 2002, Pages 29-34

https://doi.org/10.1016/S0022-510X(02)00256-3 Get rights and content

Abstract

Alzheimer's disease (AD) and vascular dementia (VaD) are the two most common forms of dementia. In Europe, 800,000 people have a diagnosis of VaD out of 3.7 million people with clinical dementia. These two dementia types share many common pathological, symptomatic and neurochemical features, and cholinergic treatments that have demonstrated robust, broad-ranging and long-term efficacy in AD are now being assessed for the treatment of dementia related to cerebrovascular disease (CVD). There has been recent recognition that dementia in the elderly is a continuum of pathologies, with pure AD and VaD representing the two extremes, and ‘mixed’ dementia (AD with CVD) in between and perhaps comprising the majority of cases. ‘Mixed’ dementia is rarely diagnosed in the clinic, however, as the majority of diagnostic procedures are biased toward a diagnosis of AD. Here, the risk factors, pathophysiological mechanisms and clinical symptoms of AD and VaD are described, identifying their overlap as well as some of the differences in both cognitive and noncognitive symptoms. Important findings indicating the high prevalence of ‘mixed’ dementia in the clinical dementia population are also discussed. In particular, evidence of a causal connection between stroke or CVD and AD is addressed. Regarding effective therapeutic management of dementia patients, further concerted epidemiological study of these related dementia types should aid in clinical decisions on the applicability of cholinergic treatments.

Section snippets

Introduction: Alzheimer's disease (AD) and vascular dementia (VaD)

The two most common forms of senile dementia are Alzheimer's disease (AD) and vascular dementia (VaD) [1], [2]. VaD is less common than AD, occurring in only 10–50% of all dementia cases [2], [3], [4], [5], and in 5.2% of all people aged over 90 years. In Europe, it is estimated that 800,000 people have a diagnosis of VaD out of the total of 3.7 million with clinical dementia.

The association between AD and VaD is complex. Both increase in prevalence with age, they frequently occur

Promise for the future

In view of the extensive similarities between VaD and AD, clinical trials are being conducted to explore the question of whether cholinergic treatment strategies that are effective in AD might also be useful in VaD [7]. Should these studies demonstrate efficacy in both types of dementia and in mixed dementia, a single treatment could be used, thereby simplifying the diagnosis and treatment of VaD and AD [56], and possibly increasing the effectiveness of disease management.

Acetylcholinesterase

Conclusions

Considerable overlap is seen in the clinical signs and symptoms (e.g., cognitive, functional and behavioral), pathological mechanisms (e.g., white matter lesions and micro-infarcts), and the associated risk factors (e.g., vascular and genetic) of VaD and AD. There is also much evidence to suggest that impairment in cholinergic function underlies the symptoms of both AD and VaD. Thus, it seems reasonable to suggest that agents used to enhance cholinergic function in patients with AD may also

Acknowledgements

Our research programmes are supported by grants from Medical Research Council (UK), Alzheimer's Research Trust (UK), NIH (NINDS) and the Alzeihmer's Association, USA (Zenith and IIRG Awards).

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View full text

Similarities between Alzheimer's disease and vascular dementia

Abstract

Section snippets

Introduction: Alzheimer's disease (AD) and vascular dementia (VaD)

Promise for the future

Conclusions

Acknowledgements

Lancet

Lancet

Neurosci. Lett.

Toxicology

Neurosci. Lett.

Eur. J. Pharmacol.

Neurosci. Lett.

J. Biol. Chem.

Lancet

Cerebrovascular dementia. Pathophysiology, diagnosis and treatment

CNS Drugs

Prevalence and outcomes of vascular cognitive impairment. Vascular Cognitive Impairment Investigators of the Canadian Study of Health and Aging

Neurology

The prevalence of VaD in Europe: facts and fragments from 1980–1990 studies. EURODEM-Prevalence Research Group

Ann. Neurol.

Epidemiology of VaD

Neuroepidemiology

Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts

Neurology

Subtypes of vascular dementia

Alzheimer Dis. Assoc. Disord.

Overlap between pathology of Alzheimer disease and vascular dementia

Alzheimer Dis. Assoc. Disord.

Introduction to ‘Meeting the challenges of dementia’

Int. J. Clin. Pract., Suppl.

Clinical deficits of Alzheimer's disease with cerebrovascular disease and probable VaD

Int. J. Clin. Pract., Suppl.

Executive control function: a rational basis for the diagnosis of vascular dementia

Alzheimer Dis. Assoc. Disord.

Outcome measures for probable vascular dementia and Alzheimer's disease with cerebrovascular disease

Int. J. Clin. Pract., Suppl.

Affective behavioural disturbances in Alzheimer's disease and ischaemic vascular disease

J. Neurol. Neurosurg. Psychiatry

Vascular dementia and Alzheimer's disease: is there a difference? A comparison of symptoms by disease duration

J. Neuropsychiatry Clin. Neurosci.

Increased sympathetic and decreased parasympathetic cardiac innervation in patients with Alzheimer's disease

Arch. Neurol.

Atrial fibrillation and dementia in a population-based study. The Rotterdam Study

Stroke

Diabetes mellitus and the risk of dementia; The Rotterdam Study

Neurology

Risk of left ventricular dysfunction in patients with probable Alzheimer's disease with APOE4 allele

J. Am. Geriatr. Soc.

Apolipoprotein E, arteriosclerosis, and Alzheimer's disease

Lancet

Apolipoprotein E polymorphism and atherosclerosis

Arteriosclerosis

Apoliprotein E alleles, dyslipidaemia, and coronary heart disease: The Framingham offspring study

JAMA

Apolipoprotein E ε4 allele in Alzheimer's disease and vascular dementia

Dementia

The apolipoprotein epsilon 4 allele is associated with increased neuritic plaques and CAA in Alzheimer's disease and Lewy body variant

Neurology