| Title | Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: case-control study. | | Author(s) | Purandare N, Burns A, Daly KJ, Hardicre J, Morris J, Macfarlane G, McCollum C | | Institution | Department of Psychiatry, University of Manchester, Manchester. | | Source | BMJ 2006 May 13; 332(7550):1119-24. | | MeSH | Aged
Alzheimer Disease
Carotid Stenosis
Case-Control Studies
Cerebrovascular Accident
Cross-Sectional Studies
Dementia, Vascular
Female
Humans
Intracranial Arteriovenous Malformations
Intracranial Embolism
Ischemic Attack, Transient
Male
Middle Cerebral Artery
Regression Analysis
Research Support, Non-U.S. Gov't
Risk Factors
| | Abstract | OBJECTIVE: To compare the occurrence of spontaneous cerebral emboli and venous to arterial circulation shunts in patients with Alzheimer's disease or vascular dementia and controls without dementia.
DESIGN: Cross sectional case-control study.
SETTING: Secondary care old age psychiatry services, Manchester.
PARTICIPANTS: 170 patients with dementia (85 with Alzheimer's disease, 85 with vascular dementia) and 150 age and sex matched controls. Patients on anticoagulant treatment, patients with severe dementia, and controls with marked cognitive impairment were excluded.
MAIN OUTCOME MEASURES: Frequencies of detection of spontaneous cerebral emboli during one hour monitoring of the middle cerebral arteries with transcranial Doppler and venous to arterial circulation shunts by a transcranial Doppler technique using intravenous microbubbles as an ultrasound contrast.
RESULTS: Spontaneous cerebral emboli were detected in 32 (40%) of patients with Alzheimer's disease and 31 (37%) of those with vascular dementia compared with just 12 each (15% and 14%) of their controls, giving significant odds ratios adjusted for vascular risk factors of 2.70 (95% confidence interval 1.18 to 6.21) for Alzheimer's disease and 5.36 (1.24 to 23.18) for vascular dementia. These spontaneous cerebral emboli were not caused by carotid disease, which was equally frequent in dementia patients and their controls. A venous to arterial circulation shunt indicative of patent foramen ovale was found in 27 (32%) Alzheimer's disease patients and 25 (29%) vascular dementia patients compared with 19 (22%) and 17 (20%) controls, giving non-significant odds ratios of 1.57 (0.80 to 3.07) and 1.67 (0.81 to 3.41).
CONCLUSION: Spontaneous cerebral emboli were significantly associated with both Alzheimer's disease and vascular dementia. They may represent a potentially preventable or treatable cause of dementia. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 16648133 |
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