cardiovascular-agents and Dementia--Vascular

Intracranial artery stenosis (ICAS) is a narrowing of an intracranial artery, which is a common etiology for ischemic stroke. In this commentary, we review key aspects of the discrimination between non-stroke controls and ischemic stroke patients on the background of phospholipid ω3-fatty acid (DHA, EPA) composition. The discussion is embedded in the presentation of general effects of long-chain ω3 polyunsaturated fatty acids (PUFAs) in cardio-cerebro-vascular diseases (CCVDs) and Alzheimer dementia (AD).. ICAS is a common stroke subtype and has emerged as a major factor in recurrent stroke and vascular mortality. DHA and EPA are important fatty acids to distinguish between NCAS (no cerebral arteriosclerotic stenosis) and ICAS in stroke. The risk of ICAS is inversely correlated with the DHA content in phospholipids. Furthermore, a mechanistic explanation has been proposed for the beneficial effects of PUFAs in CCVDs and AD.. Whereas the beneficial effects of EPA/DHA for cardiovascular diseases and stroke seem to be beyond question, preventive effects in patients with very mild cognitive dysfunction and beginning Alzheimer's disease undoubtedly need confirmation by larger clinical trials. A collaborative international basic science approach is warranted considering cautiously designed studies in order to avoid ethical problems.

Topics: Alzheimer Disease; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Constriction, Pathologic; Dementia, Vascular; Diet; Dietary Supplements; Fatty Acids, Omega-3; Humans; Intracranial Arterial Diseases; Nutrition Policy; Stroke

Dementia is one of the most important neurological disorders in the elderly. Aging is associated with a large increase in the prevalence and incidence of degenerative (Alzheimer's disease) and vascular dementia, leading to a devastating loss of autonomy. In view of the increasing longevity of populations worldwide, prevention of dementia has turned into a major public health challenge. In the past decade, several vascular risk factors have been found to be associated with vascular dementia but also Alzheimer's disease. Some longitudinal studies, have found significant associations between hypertension, diabetus mellitus, and metabolic syndrome, assessed at middle age, and dementia. Studies assessing the link between hypercholesterolemia, atrial fibrillation, smoking, and dementia have given more conflicting results. Furthermore, some studies have highlighted the possible protective effect of antihypertensive therapy on cognition and some trials are evaluating the effects of statins and treatments for insulin resistance. Vascular risk factors and their treatments are a promising avenue of research for prevention of dementia, and further long-term, placebo-controlled, randomized studies, need to be performed.

Topics: Alzheimer Disease; Apolipoproteins E; Atrial Fibrillation; Cardiovascular Agents; Cardiovascular Diseases; Cognition; Dementia, Vascular; Diabetes Complications; Humans; Hypercholesterolemia; Hypertension; Metabolic Syndrome; Risk Factors; Smoking

The prevalence of mixed dementia, defined as the coexistence of Alzheimer disease (AD) and vascular dementia (VaD), is likely to increase as the population ages.. To provide an overview of the diagnosis, pathophysiology, and interaction of AD and VaD in mixed dementia, and to provide a systematic literature review of the current evidence for the pharmacologic therapy of mixed dementia.. The Cochrane Database of Systematic Reviews was searched using the keyword dementia. MEDLINE was searched for English-language articles published within the last 10 years using the keywords mixed dementia, the combination of keywords Alzheimer disease, cerebrovascular disorders, and drug therapy, and the combination of keywords vascular dementia and drug therapy.. Dementia is more likely to be present when vascular and AD lesions coexist, a situation that is especially common with increasing age. The measured benefits in clinical trials for the treatment of mixed dementia are best described as statistically significant differences in cognitive test scores and clinician and caregiver impressions of change. In these studies, the control groups' scores typically decline while the treatment groups improve slightly or decline to a lesser degree over the study period. Nevertheless, even the patients who experience treatment benefits eventually decline. Cholinesterase inhibitor (ChI) therapy for mixed dementia shows modest clinical benefits that are similar to those found for ChI treatment of AD. The N-methyl-D-aspartate (NMDA) antagonist memantine also shows modest clinical benefits for the treatment of moderate to severe AD and mild to moderate VaD, but it has not been studied specifically in mixed dementia. The treatment of cardiovascular risk factors, especially hypertension, may be a more effective way to protect brain function as primary, secondary, and tertiary prevention for mixed dementia.. Currently available medications provide only modest clinical benefits once a patient has developed mixed dementia. Cardiovascular risk factor control, especially for hypertension and hyperlipidemia, as well as other interventions to prevent recurrent stroke, likely represent important strategies for preventing or slowing the progression of mixed dementia. Additional research is needed to define better what individuals and families hope to achieve from dementia treatment and to determine the most appropriate use of medication to achieve these goals.

Topics: Alzheimer Disease; Cardiovascular Agents; Cholinesterase Inhibitors; Comorbidity; Dementia, Vascular; Excitatory Amino Acid Antagonists; Humans; Risk

Secondary analyses of a randomised controlled trial were performed to find out whether treatment effects of Ginkgo biloba extract EGb 761 differed by type of dementia. Three hundred ninety-five patients aged 50 years or above, with dementia with neuropsychiatric features were treated with EGb 761 (240 mg/day) or placebo for 22 weeks. Patients scored between 9 and 23 on the Short Syndrome Test (SKT), a cross-culturally validated cognitive test battery. Their total score on the Neuropsychiatric Inventory (NPI) was at least 5. Efficacy was assessed by the SKT test battery (primary outcome measure), the Verbal Fluency Test, the Clock-Drawing Test, the NPI, the Hamilton Rating Scale for Depression (HAMD), and the Gottfries-Bråne-Steen Scale (GBS). Applying standard research diagnostic criteria 214 patients were diagnosed with Alzheimer's disease (probable AD or possible AD with cerebrovascular disease) and 181 with probable vascular dementia (VaD). Under EGb 761 treatment the SKT total score improved by -3.0+/-2.3 and -3.4+/-2.3 points in patients with AD and VaD, respectively, whereas the patients on placebo deteriorated by +1.2+/-2.5 and +1.5+/-2.2 points, respectively (p<0.01 for both drug-placebo differences). Significant drug-placebo differences were found for all secondary outcome variables with no major differences between AD and VaD subgroups. The rate of adverse events tended to be higher for the placebo group.

Topics: Aged; Alzheimer Disease; Cardiovascular Agents; Dementia, Vascular; Female; Ginkgo biloba; Humans; Male; Neuropsychological Tests; Plant Extracts; Psychiatric Status Rating Scales; Treatment Outcome

To observe the validity and safety of Kangxin capsule curing the patients with vascular dementia (VaD).. Fifty-six patients with vascular dementia of kidney deficiency and blood stagnation type were selected on the basis of defined diagnostic criteria and were randomly divided into Kangxin group (29) and control group (27), observing the relevant accumulation scores in dementia scale before and after treatment and changes of endothelin (ET), sex hormone, immunity and routine examinations.. Kangxin capsule can effectively improve the symptom of patients with VaD of senile kidney deficiency and blood stagnation type, and the average value of curative effect index of 29 patients in the treatment group is 23.01>/=20%, i.e. effective; compared with that before treatment, both CD(4) and CD(4).CD(8)(-1) rises (P<0.05) after the treatment with Kangxin capsule; for the male VaD patients of the Kangxin group, T level increases (P<0.05) and estrodial (E(2)).testerone (T)(-1) value decreases (P<0.05) after the treatment; for the female VaD patients of the Kangxin group, E(2), E(2).T(-1) value increases a great deal (P<0.05) compared with that before treatment; ET level of both groups decreased on average (P<0.01), and did not demonstrate any obvious toxic side effect.. Kangxin capsule is a valid and safe preparation of Chinese traditional medicine for curing VaD of senile kidney deficiency and blood stagnation type.

Topics: Aged; Aging; Capsules; Cardiovascular Agents; CD4 Lymphocyte Count; CD8-Positive T-Lymphocytes; Dementia, Vascular; Double-Blind Method; Drugs, Chinese Herbal; Endothelins; Female; Gonadal Steroid Hormones; Hematologic Diseases; Humans; Killer Cells, Natural; Male; Middle Aged; Psychiatric Status Rating Scales; Renal Insufficiency

In a randomised, double-blind, 22-week trial 400 patients with dementia associated with neuropsychiatric features were treated with Ginkgo biloba extract EGb 761 (240 mg/day) or placebo. Patients with probable Alzheimer's disease, possible Alzheimer's disease with cerebrovascular disease or vascular dementia were eligible if they scored 9 to 23 on the SKT cognitive test battery and at least 5 on the Neuropsychiatric Inventory (NPI). EGb 761 was significantly superior to placebo with respect to the primary (SKT test battery) and all secondary outcome variables. The mean composite score (frequency x severity) and the mean caregiver distress score of the NPI dropped from 21.3 to 14.7 and 13.5 to 8.7, respectively, in the EGb 761-treated patients, but increased from 21.6 to 24.1 and 13.4 to 13.9, respectively, under placebo (p < 0.001). The largest drug-placebo differences in favour of EGb 761 were found for apathy/indifference, anxiety, irritability/lability, depression/dysphoria and sleep/nighttime behaviour.

Topics: Aged; Alzheimer Disease; Cardiovascular Agents; Dementia; Dementia, Vascular; Double-Blind Method; Geriatric Assessment; Ginkgo biloba; Humans; Middle Aged; Neuropsychological Tests; Phytotherapy; Plant Extracts; Time Factors; Treatment Outcome

Epidemiologic studies on age-specific incidence rates (IRs) separating Alzheimer's disease (AD) and vascular dementia (VaD) in the UK are scarce. We sought to assess IRs of AD and VaD in the UK and to compare co-morbidities and medication use between patients with AD, VaD, or without dementia. We identified cases aged ≥65 years with an incident diagnosis of AD or VaD between 1998 and 2008 using the General Practice Research Database (GPRD). We assessed IRs, stratified by age and gender, matched one dementia-free control patient to each demented patient, and analyzed co-morbidities and medication use. We identified 7,086 AD and 4,438 VaD cases. Overall, the IR of AD was 1.59/1,000 person-years (py) (95% CI 1.55-1.62) and the IR of VaD 0.99/1,000 py (95% CI 0.96-1.02). For AD, IRs were higher for women than for men, but not for VaD. Except for orthostatic hypotension, the prevalence of all cardiovascular (CV) co-morbidities and exposure to CV drugs was lower in patients with AD than in corresponding controls, whereas the opposite was true for VaD. The lower prevalence of CV diseases in patients with AD may be a true finding or the result of a channeling effect, i.e., the possibility that demented patients with CV diseases may be more likely diagnosed with VaD than AD.

Topics: Age Factors; Aged; Aged, 80 and over; Alzheimer Disease; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Cross-Sectional Studies; Dementia, Vascular; Female; Humans; Incidence; Male; Middle Aged; Nootropic Agents; Sex Factors; United Kingdom

Acetazolamide vasoreactive test measures the increment of cerebral blood flow caused by compensatory vasodilatation ability of cerebral vessels which can be detected by transcranial Doppler ultrasound (TCD). This study aimed to compare the vascular reactivity in patients with vascular dementia (VaD) and Alzheimer's disease (AD).. AD and VaD patients were recruited from the King Chulalongkorn Hospital Dementia Clinic. Thai Mini-mental State Examination was used for dementia detection. AD and possible VaD were defined by NINCDS/ADRDA and NINDS-AIREN criteria. Patients with extracranial carotid artery stenosis >50% and intracranial artery stenosis were excluded. TCD examination was performed using DWL Multi Dop-T. TCD was performed on MCA with insonation depth between 45 and 60 mm. Baseline end diastolic velocity (EDV), mid systolic velocity (MSV) and peak systolic velocity (PSV) were recorded. The velocities were obtained at 2, 5, 10 and 20 min after acetazolamide (1000 mg) injection. Mean baseline velocities (Vo) and velocities after acetazolamide injection (Va) were compared. Percentage of mean increment velocities was calculated {[(Va-Vo)/Vo]x100%}. Percentage differences of mean velocity change from Vo to Va at each recorded minute were compared. SPSS for Windows version 11.5.0. was used.. Nine AD (5 males) and 9 VaD (6 males) were selected. Average ages of VaD and AD groups were 66.11 years-old and 75.22 years-old respectively. Mini-mental State Examination (MMSE) score in VaD and AD were 21.13 and 19.00. Mean baseline EDV and MSV in VaD were higher than AD but mean PSV was lower. The percentage of velocity change after acetazolamide in AD was higher than VaD at 5, 10 and 20 min. However the differences were not statistically significant.. Acetazolamide vasoreactive test using TCD may be the additional criterion to differentiate VaD from AD. Further study with more number of subjects for the study or higher dose of acetazolamide may be needed to reveal the significant difference of vasoreactive response between VaD and AD patients.

Topics: Acetazolamide; Aged; Aged, 80 and over; Alzheimer Disease; Brain; Cardiovascular Agents; Cerebrovascular Circulation; Dementia, Vascular; Diagnosis, Differential; Echoencephalography; Female; Humans; Male; Middle Aged; Middle Cerebral Artery; Time Factors; Ultrasonography, Doppler, Transcranial

Atrial fibrillation is a frequent disorder in the elderly and a known risk factor for cerebrovascular stroke. We investigated the association of atrial fibrillation with dementia and cognitive impairment in a large cross-sectional, population-based study in the elderly.. Of the 6584 participants in the Rotterdam Study aged 55 to 106 years, detailed information on dementia status and ECG abnormalities was available. Dementia was diagnosed in three phases. First, participants were screened. Screen-positive subjects were tested further. Those with possible dementia underwent an extensive diagnostic workup. Dementia and dementia subtypes were diagnosed according to prevailing criteria. Cognitive impairment was defined as a Mini-Mental State Examination test score of < 26 points for a nondemented subject.. Atrial fibrillation was diagnosed in 195, dementia in 276, and cognitive impairment in 635 subjects. We found significant positive associations of atrial fibrillation with both dementia and impaired cognitive function (age- and sex-adjusted odds ratios, 2.3 [95% confidence interval, 1.4 to 3.7] and 1.7 [95% confidence interval, 1.2 to 2.5]), respectively). The strongest association was found not for vascular dementia but rather for Alzheimer's disease with cerebrovascular disease. The associations were stronger in women, and the relation with dementia was more pronounced in the relatively younger elderly. A history of stroke in subjects with atrial fibrillation could not account for these associations.. Dementia and subtypes Alzheimer's disease and vascular dementia may be related to atrial fibrillation even if no clinical stokes have occurred.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiac Output, Low; Cardiovascular Agents; Cerebrovascular Circulation; Cognition Disorders; Comorbidity; Cross-Sectional Studies; Dementia; Dementia, Vascular; Electrocardiography; Female; Humans; Male; Middle Aged; Netherlands; Prevalence; Risk Factors