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

Abstract

BACKGROUND

Increasing 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.

METHODS

Studies 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.

RESULTS

The 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.

CONCLUSIONS

Observational 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.

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  • Authors+Show Affiliations

    , ,

    Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. hsm32@medschl.cam.ac.uk.

    Source

    BMC medicine 12: 2014 Nov 11 pg 160

    MeSH

    Alzheimer Disease
    Humans
    Observational Studies as Topic
    Randomized Controlled Trials as Topic
    Risk Factors
    Stroke

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    25385407

    Citation

    Valenti, Raffaella, et al. "Treatment of Vascular Risk Factors in Patients With a Diagnosis of Alzheimer's Disease: a Systematic Review." BMC Medicine, vol. 12, 2014, p. 160.
    Valenti R, Pantoni L, Markus HS. Treatment of vascular risk factors in patients with a diagnosis of Alzheimer's disease: a systematic review. BMC Med. 2014;12:160.
    Valenti, R., Pantoni, L., & Markus, H. S. (2014). Treatment of vascular risk factors in patients with a diagnosis of Alzheimer's disease: a systematic review. BMC Medicine, 12, p. 160. doi:10.1186/s12916-014-0160-z.
    Valenti R, Pantoni L, Markus HS. Treatment of Vascular Risk Factors in Patients With a Diagnosis of Alzheimer's Disease: a Systematic Review. BMC Med. 2014 Nov 11;12:160. PubMed PMID: 25385407.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Treatment of vascular risk factors in patients with a diagnosis of Alzheimer's disease: a systematic review. AU - Valenti,Raffaella, AU - Pantoni,Leonardo, AU - Markus,Hugh S, Y1 - 2014/11/11/ PY - 2014/07/05/received PY - 2014/08/20/accepted PY - 2014/11/12/entrez PY - 2014/11/12/pubmed PY - 2015/5/29/medline SP - 160 EP - 160 JF - BMC medicine JO - BMC Med VL - 12 N2 - BACKGROUND: Increasing 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. METHODS: Studies 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. RESULTS: The 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. CONCLUSIONS: Observational 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. SN - 1741-7015 UR - https://www.unboundmedicine.com/medline/citation/25385407/full_citation L2 - https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0160-z DB - PRIME DP - Unbound Medicine ER -