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Viticchi G, Falsetti L, Potente E, Bartolini M, Silvestrini M. Impact of carotid stenosis on cerebral hemodynamic failure and cognitive impairment progression: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1209. [PMID: 34430650 PMCID: PMC8350657 DOI: 10.21037/atm-20-7226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022]
Abstract
Carotid atherosclerosis has a relevant impact on cerebral blood flow regulation. There is accruing evidence that hemodynamic impairment related to the presence of a significant carotid lumen narrowing may predispose to the development of cerebral dysfunctions, including a reduction in cognitive abilities. In the last years an increasing number of findings showed that carotid stenosis did contribute to cognitive impairment not only in relation to the occurrence of cerebral ischemic lesions, but also as an independent risk factor. The principal mechanisms involved are chronic hypoperfusion, microembolization and cerebrovascular reactivity impairment. Moreover, more recent studies showed alterations of regional functional connectivity. In this narrative review, we analyzed the relationships between carotid stenosis, cerebral hemodynamic derangement and cognitive impairment onset and progression, and underlined that cognitive impairment is the final result of the complex interaction between different elements, including also collateral circulation, cerebral hemodynamic status, brain connectivity and pro-inflammatory state. Further, therapeutic approaches, with a specific focus on vascular risk factors correction and on the effectiveness of surgical or endovascular interventions were discussed. We particularly focused our attention on the concept of “asymptomatic carotid stenosis”, and how could a cognitive impairment improve after an intervention, and how this could change the indications to surgical approach. Larger studies and randomized controlled trials are urgently required to better define time, characteristics and effectiveness of both medical and surgical/endovascular approaches.
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Affiliation(s)
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Italy
| | - Eleonora Potente
- Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Marco Bartolini
- Neurological Clinic, Marche Polytechnic University, Ancona, Italy
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Wright JW, Harding JW. Contributions by the Brain Renin-Angiotensin System to Memory, Cognition, and Alzheimer's Disease. J Alzheimers Dis 2020; 67:469-480. [PMID: 30664507 DOI: 10.3233/jad-181035] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive neuron losses in memory-associated brain structures that rob patients of their dignity and quality of life. Five drugs have been approved by the FDA to treat AD but none modify or significantly slow disease progression. New therapies are needed to delay the course of this disease with the ultimate goal of preventing neuron losses and preserving memory functioning. In this review we describe the renin-angiotensin II (AngII) system (RAS) with specific regard to its deleterious contributions to hypertension, facilitation of neuroinflammation and oxidative stress, reduced cerebral blood flow, tissue remodeling, and disruption of memory consolidation and retrieval. There is evidence that components of the RAS, AngIV and Ang(1-7), are positioned to counter such damaging influences and these systems are detailed with the goal of drawing attention to their importance as drug development targets. Ang(1-7) binds at the Mas receptor, while AngIV binds at the AT4 receptor subtype, and these receptor numbers are significantly decreased in AD patients, accompanied by declines in brain aminopeptidases A and N, enzymes essential for the synthesis of AngIV. Potent analogs may be useful to counter these changes and facilitate neuronal functioning and reduce apoptosis in memory associated brain structures of AD patients.
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Affiliation(s)
- John W Wright
- Department of Psychology, Washington State University, Pullman, WA, USA.,Department of Integrative Physiology and Neuroscience, and Program in Biotechnology, Washington State University, Pullman, WA, USA.,M3 Biotechnology, Inc., Seattle, WA, USA
| | - Joseph W Harding
- Department of Psychology, Washington State University, Pullman, WA, USA.,Department of Integrative Physiology and Neuroscience, and Program in Biotechnology, Washington State University, Pullman, WA, USA.,M3 Biotechnology, Inc., Seattle, WA, USA
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3
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de la Torre J. The Vascular Hypothesis of Alzheimer's Disease: A Key to Preclinical Prediction of Dementia Using Neuroimaging. J Alzheimers Dis 2019; 63:35-52. [PMID: 29614675 DOI: 10.3233/jad-180004] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The vascular hypothesis of Alzheimer's disease (VHAD) was proposed 24 years ago from observations made in our laboratory using aging rats subjected to chronic brain hypoperfusion. In recent years, VHAD has become a mother-lode to numerous neuroimaging studies targeting cerebral hemodynamic changes, particularly brain hypoperfusion in elderly patients at risk of developing Alzheimer's disease (AD). There is a growing consensus among neuroradiologists that brain hypoperfusion is likely involved in the pathogenesis of AD and that disturbed cerebral blood flow (CBF) can serve as a key biomarker for predicting conversion of mild cognitive impairment to AD. The use of cerebral hypoperfusion as a preclinical predictor of AD is becoming decisive in stratifying low and high risk patients that may develop cognitive decline and for assessing the effectiveness of therapeutic interventions. There is currently an international research drive from neuroimaging groups to seek new perspectives that can broaden our understanding of AD and improve lifestyle. Diverse neuroimaging methods are currently being used to monitor normal and dyscognitive brain activity. Some techniques are very powerful and can detect, diagnose, quantify, prognose, and predict cognitive decline before AD onset, even from a healthy cognitive state. Multimodal imaging offers new insights in the treatment and prevention of cognitive decline during advanced aging and better understanding of the functional and structural organization of the human brain. This review discusses the impact the VHAD and CBF are having on the neuroimaging technology that can usher practical strategies to help prevent AD.
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Affiliation(s)
- Jack de la Torre
- Department of Psychology, University of Texas, Austin, Austin, TX, USA
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Hede V, Devillé C. Treating psychiatric symptoms and disorders with non-psychotropic medications. DIALOGUES IN CLINICAL NEUROSCIENCE 2019. [PMID: 31636493 PMCID: PMC6787535 DOI: 10.31887/dcns.2019.21.2/vhede] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A few drugs prescribed in internal medicine, ie, non-psychotropic drugs, can be used
to treat certain neuropsychiatric disorders. For most of these situations, the level
of evidence remains low. But when sufficient data becomes available, these molecules
are then included in official guidelines for the treatment of neuropsychiatric
disorders. In this article we review interesting drugs which may be relevant from an
evidence-based medicine point of view, and could become part of psychiatric practice
in the future.
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Affiliation(s)
- Vincent Hede
- Author affiliations: Liaison Psychiatry Unit (Vincent Hede); Young Adult Psychiatry Unit (Cédric Devillé); Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland. Address for correspondence: Dr Vincent Hede, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. (e-mail: )
| | - Cédric Devillé
- Author affiliations: Liaison Psychiatry Unit (Vincent Hede); Young Adult Psychiatry Unit (Cédric Devillé); Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland. Address for correspondence: Dr Vincent Hede, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. (e-mail: )
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Nunes Santiago A, Dias Fiuza Ferreira E, Weffort de Oliveira RM, Milani H. Cognitive, neurohistological and mortality outcomes following the four-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion: The impact of diabetes and aging. Behav Brain Res 2018; 339:169-178. [DOI: 10.1016/j.bbr.2017.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
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6
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Lin YC, Lin CH, Yao HT, Kuo WW, Shen CY, Yeh YL, Ho TJ, Padma VV, Lin YC, Huang CY, Huang CY. Platycodon grandiflorum (PG) reverses angiotensin II-induced apoptosis by repressing IGF-IIR expression. JOURNAL OF ETHNOPHARMACOLOGY 2017; 205:41-50. [PMID: 28473244 DOI: 10.1016/j.jep.2017.04.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Platycodon grandiflorum (PG) is a Chinese medical plant used for decades as a traditional prescription to eliminate phlegm, relieve cough, reduce inflammation and lower blood pressure. PG also has a significant effect on the cardiovascular systems. MATERIALS AND METHODS The aqueous extract of Platycodon grandiflorum (JACQ.) A. DC. root was screened for inhibiting Ang II-induced IGF-IIR activation and apoptosis pathway in H9c2 cardiomyocytes. The effects were also studied in spontaneously hypertensive rats (five groups, n=5) using low and high doses of PG for 50 days. The Ang II-induced IGF-IIR activation was analyzed by luciferase reporter, RT-PCR, western blot and surface IGF-IIR expression assay. Furthermore, the major active constituent of PG was carried out by high performance liquid chromatography-mass spectrometry (HPLC-MS). RESULTS Our results indicate that a crude extract of PG significantly suppresses the Ang II-induced IGF-IIR signaling pathway to prevent cardiomyocyte apoptosis. PG extract inhibits Ang II-mediated JNK activation and SIRT1 degradation to reduce IGF-IIR activity. Moreover, PG maintains SIRT1 stability to enhance HSF1-mediated IGF-IIR suppression, which prevents cardiomyocyte apoptosis. In animal models, the administration of PG markedly reduced this apoptotic pathway in the heart of SHRs. CONCLUSION Taken together, PG may be considered as an effective treatment for cardiac diseases in hypertensive patients.
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Affiliation(s)
- Yuan-Chuan Lin
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Chih-Hsueh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsien-Tsung Yao
- Department of Nutrition, China Medical University, Taichung, Taiwan
| | - Wei-Wen Kuo
- Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Chia-Yao Shen
- Department of Nursing, Mei Ho University, Pingguang Road, Pingtung, Taiwan
| | - Yu-Lan Yeh
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan; Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Tsung-Jung Ho
- Chinese Medicine Department, China Medical University Beigang Hospital, Taichung, Taiwan
| | - V Vijaya Padma
- Department of Biotechnology, Bharathiar University, Coimbatore 641046, India
| | - Yu-Chen Lin
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Chih-Yang Huang
- Translation Research Core, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chih-Yang Huang
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan; Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan; Department of Biological Science, Asia University, Taichung, Taiwan; Faculty of Applied Sciences, Ton Duc Thang University, Tan Phong Ward, District 7, 700000 Ho Chi Minh City, Vietnam.
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7
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Difficulty, effort and cardiovascular response to a working memory challenge: Older adults with and without mild cognitive impairment. Int J Psychophysiol 2016; 104:53-61. [DOI: 10.1016/j.ijpsycho.2016.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/17/2016] [Accepted: 04/20/2016] [Indexed: 11/23/2022]
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Glodzik L, Rusinek H, Kamer A, Pirraglia E, Tsui W, Mosconi L, Li Y, McHugh P, Murray J, Williams S, Osorio RS, Randall C, Butler T, Deshpande A, Vallabhajolusa S, de Leon M. Effects of vascular risk factors, statins, and antihypertensive drugs on PiB deposition in cognitively normal subjects. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 2:95-104. [PMID: 27239540 PMCID: PMC4879519 DOI: 10.1016/j.dadm.2016.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Hypertension, hypercholesterolemia, and obesity increase the risk of dementia. Although their detection is commonly followed by an introduction of treatment, little is known about how medications frequently used to treat vascular risk affect amyloid deposition. METHODS A cross-sectional study of 156 subjects who underwent positron emission tomography with PiB. Using linear regression, we tested whether blood pressure, cholesterol, overweight/obese status, angiotensin receptor blockers (ARBs), beta-blockers, diuretics, angiotensin converting enzyme inhibitors, and statins predicted amyloid deposition. RESULTS The use of ARBs (β = -.15, P = .044) and diuretics (β = -.20, P = .006) predicted less amyloid accumulation; older age (β = .29, P < .001) and statins (β = .23, P = .004) were related to greater amyloid deposition. Overweight and/or obese women had more cortical amyloid than their peers. DISCUSSION Prospective studies should confirm effects of drugs and increased body weight on amyloid accumulation and establish whether they translate into measurable clinical outcomes. Women may be more susceptible to harmful effects of obesity.
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Affiliation(s)
- Lidia Glodzik
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
- Department of Radiology, NYU School of Medicine, New York, USA
- Corresponding author. Tel.: +1 212 263 5698; Fax: +1 212 263 3270.
| | - Henry Rusinek
- Department of Radiology, NYU School of Medicine, New York, USA
| | - Angela Kamer
- Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, USA
| | - Elizabeth Pirraglia
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | - Wai Tsui
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | - Lisa Mosconi
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | - Yi Li
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | - Pauline McHugh
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | - John Murray
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | | | - Ricardo S. Osorio
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | - Catherine Randall
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | - Tracy Butler
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | - Anup Deshpande
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
| | | | - Mony de Leon
- Department of Psychiatry, Center for Brain Health, NYU School of Medicine, New York, USA
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9
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Altamura C, Scrascia F, Quattrocchi CC, Errante Y, Gangemi E, Curcio G, Ursini F, Silvestrini M, Maggio P, Beomonte Zobel B, Rossini PM, Pasqualetti P, Falsetti L, Vernieri F. Regional MRI Diffusion, White-Matter Hyperintensities, and Cognitive Function in Alzheimer's Disease and Vascular Dementia. J Clin Neurol 2016; 12:201-8. [PMID: 27074295 PMCID: PMC4828567 DOI: 10.3988/jcn.2016.12.2.201] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/10/2015] [Accepted: 05/13/2015] [Indexed: 02/04/2023] Open
Abstract
Background and Purpose An increase in brain water diffusivity as measured using magnetic resonance imaging (MRI) has been recently reported in normal-appearing white matter (NAWM) in patients affected by cognitive impairment. However, it remains to be clarified if this reflects an overt neuronal tissue disruption that leads to degenerative or microvascular lesions. This question was addressed by comparing the regional MRI apparent diffusion coefficients (ADCs) of NAWM in patients affected by Alzheimer's disease (AD) or vascular dementia (VaD). The relationships of ADCs with the white-matter hyperintensity (WMH) burden, carotid atherosclerosis, and cognitive performance were also investigated. Methods Forty-nine AD and 31 VaD patients underwent brain MRI to assess the WMH volume and regional NAWM ADCs, neuropsychological evaluations, and carotid ultrasound to assess the plaque severity and intima-media thickness (IMT). Results Regional ADCs in NAWM did not differ between VaD and AD patients, while the WMH volume was greater in VaD than in AD patients. The ADC in the anterior corpus callosum was related to the WMH volume, while a greater carotid IMT was positively correlated with the temporal ADC and WMH volume. The memory performance was worse in patients with higher temporal ADCs. Constructional praxis scores were related to ADCs in the frontal, and occipital lobes, in the anterior and posterior corpus callosum as well as to the WMH volume. Abstract reasoning was related to frontal, parietal, and temporal ADCs. Conclusions Our data show that higher regional ADCs in NAWM are associated with microcirculatory impairment, as depicted by the WMH volume. Moreover, regional ADCs in NAWM are differently associated with the neuropsychological performances in memory, constructional praxia, and abstract reasoning domains.
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Affiliation(s)
| | | | | | - Yuri Errante
- Radiology Unit, Campus Bio-Medico University, Rome, Italy
| | - Emma Gangemi
- Radiology Unit, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Curcio
- Clinical Medicine Department, Public Health, Life and Environment Scinces, University of L'Aquila, Italy.,IRCCS S. Raffaele, Rome - S.Raffaele Clinic, Cassino (FR), Italy
| | | | - Mauro Silvestrini
- Neurology Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Paola Maggio
- Neurology Unit, Campus Bio-Medico University, Rome, Italy
| | | | | | | | - Lorenzo Falsetti
- Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Italy
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Zaghi GGD, Godinho J, Ferreira EDF, Ribeiro MHDM, Previdelli IS, de Oliveira RMW, Milani H. Robust and enduring atorvastatin-mediated memory recovery following the 4-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion in middle-aged rats. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:179-87. [PMID: 26485403 DOI: 10.1016/j.pnpbp.2015.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/12/2022]
Abstract
Chronic cerebral hypoperfusion (CCH) is a common condition associated with the development and/or worsening of age-related dementia.We previously reported persistent memory loss and neurodegeneration after CCH in middle-aged rats. Statin-mediated neuroprotection has been reported after acute cerebral ischemia. Unknown, however, is whether statins can alleviate the outcome of CCH. The present study investigated whether atorvastatin attenuates the cognitive and neurohistological outcome of CCH. Rats (12–15 months old) were trained in a non-food-rewarded radial maze, and then subjected to CCH. Atorvastatin (10 mg/kg, p.o.) was administered for 42 days or 15 days, beginning 5 h after the first occlusion stage. Retrograde memory performance was assessed at 7, 14, 21, 28, and 35 days of CCH, and expressed by “latency,” “number of reference memory errors” and “number of working memory errors.” Neurodegeneration was then examined at the hippocampus and cerebral cortex. Compared to sham, CCH caused profound and persistent memory loss in the vehicle-treated groups, as indicated by increased latency (91.2% to 107.3%) and number of errors (123.5% to 2508.2%), effects from which the animals did not spontaneously recover across time. This CCH-induced retrograde amnesia was completely prevented by atorvastatin (latency: −4.3% to 3.3%; reference/working errors: −2.5% to 45.7%), regardless of the treatment duration. This effect was sustained during the entire behavioral testing period (5 weeks), even after discontinuing treatment. This robust and sustained memory-protective effect of atorvastatin occurred in the absence of neuronal rescue (39.58% to 56.45% cell loss). We suggest that atorvastatin may be promising for the treatment of cognitive sequelae associated with CCH.
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Affiliation(s)
| | - Jacqueline Godinho
- Department of Pharmacology and Therapeutics, Health Science Center, Brazil
| | | | - Matheus Henrique Dal Molin Ribeiro
- Department of Statistics, Exact Science Center, State University of Maringá, Maringá, Brazil; Federal Institute of Parana, Palmas, Paraná, Brazil
| | | | | | - Humberto Milani
- Department of Pharmacology and Therapeutics, Health Science Center, Brazil.
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Desai P, Shete H, Adnaik R, Disouza J, Patravale V. Therapeutic targets and delivery challenges for Alzheimer’s disease. World J Pharmacol 2015; 4:236-264. [DOI: 10.5497/wjp.v4.i3.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/29/2015] [Accepted: 08/11/2015] [Indexed: 02/06/2023] Open
Abstract
Dementia, including Alzheimer’s disease, the 21st Century epidemic, is one of the most significant social and health crises which has currently afflicted nearly 44 million patients worldwide and about new 7.7 million cases are reported every year. This portrays the unmet need towards better understanding of Alzheimer’s disease pathomechanisms and related research towards more effective treatment strategies. The review thus comprehensively addresses Alzheimer’s disease pathophysiology with an insight of underlying multicascade pathway and elaborates possible therapeutic targets- particularly anti-amyloid approaches, anti-tau approaches, acetylcholinesterase inhibitors, glutamatergic system modifiers, immunotherapy, anti-inflammatory targets, antioxidants, 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors and insulin. In spite of extensive research leading to identification of newer targets and potent drugs, complete cure of Alzheimer’s disease appears to be an unreached holy grail. This can be attributed to their ineffective delivery across blood brain barrier and ultimately to the brain. With this understanding, researchers are now focusing on development of drug delivery systems to be delivered via suitable route that can circumvent blood brain barrier effectively with enhanced patient compliance. In this context, we have summarized current drug delivery strategies by oral, transdermal, intravenous, intranasal and other miscellaneous routes and have accentuated the future standpoint towards promising therapy ultimately leading to Alzheimer’s disease cure.
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Godinho J, de Oliveira JN, Ferreira EDF, Zaghi GGD, Bacarin CC, de Oliveira RMW, Milani H. Cilostazol but not sildenafil prevents memory impairment after chronic cerebral hypoperfusion in middle-aged rats. Behav Brain Res 2015; 283:61-8. [DOI: 10.1016/j.bbr.2015.01.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 01/02/2023]
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13
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Ferreira EDF, Romanini CV, de Oliveira JN, Previdelli ITS, de Melo SR, de Oliveira RMW, Milani H. Fish oil provides a sustained antiamnesic effect after acute, transient forebrain ischemia but not after chronic cerebral hypoperfusion in middle-aged rats. Behav Brain Res 2014; 265:101-10. [PMID: 24561066 DOI: 10.1016/j.bbr.2014.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/06/2014] [Accepted: 02/10/2014] [Indexed: 01/04/2023]
Abstract
We reported that fish oil (FO) abolishes retrograde amnesia consistently following transient global cerebral ischemia (TGCI) in young rats, provided it covered the first days prior to and after ischemia. Here, we further evaluated whether FO given post-ischemia in older rats (15-18 months old) is equally effective in facilitating memory recovery. We also tested whether the antiamnesic effect of FO observed after TGCI can be reproduced after chronic cerebral hypoperfusion (CCH). FO (300 mg/kg docosahexaenoic acid [DHA]) was delivered orally 4h after TGCI and continued once per day for 9 days. In the CCH group, FO treatment began soon after the first stage of 4-VO/ICA and continued daily for 43 days. Two weeks after surgery, the animals were tested for retrograde memory performance across 5 weeks. Both TGCI and CCH caused persistent memory impairment and hippocampal and cortical neurodegeneration. TGCI-induced retrograde amnesia was reversed by FO, an effect that was sustained for at least 5 weeks after discontinuing treatment. In contrast, the memory deficit caused by CCH remained unchanged after FO treatment. Both hippocampal and cortical damage was not alleviated by FO. We conclude that the FO-mediated antiamnesic effect following TGCI can be extended to older rats, even when the treatment begins 4h postischemia. Such efficacy was not reproduced after CCH. Therefore, the present results support the notion that FO may have therapeutic utility in treating learning/memory dysfunction after acute/transient cerebral ischemia and suggest that such benefits may not apply when a state of chronic cerebrovascular insufficiency is present.
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Affiliation(s)
- Emilene Dias Fiuza Ferreira
- Department of Pharmacology and Therapeutic, Health Science Center, State University of Maringá, Maringá 87020-900, PR, Brazil
| | - Cássia Valério Romanini
- Department of Pharmacology and Therapeutic, Health Science Center, State University of Maringá, Maringá 87020-900, PR, Brazil
| | - Janaina Nicolau de Oliveira
- Department of Pharmacology and Therapeutic, Health Science Center, State University of Maringá, Maringá 87020-900, PR, Brazil
| | | | - Silvana Regina de Melo
- Department of Morphophysiological Sciences, Biological Science Center, State University of Maringá, Maringá 87020-900, PR, Brazil
| | - Rúbia Maria Weffort de Oliveira
- Department of Pharmacology and Therapeutic, Health Science Center, State University of Maringá, Maringá 87020-900, PR, Brazil
| | - Humberto Milani
- Department of Pharmacology and Therapeutic, Health Science Center, State University of Maringá, Maringá 87020-900, PR, Brazil.
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Monacelli F, Odetti P, Sartini M, Parodi A, Brunelli C, Rosa G. Cardioprotection and anticholinesterases in patients with Alzheimer's disease: time for reappraisal. Dement Geriatr Cogn Dis Extra 2014; 4:45-50. [PMID: 24711813 PMCID: PMC3977226 DOI: 10.1159/000357124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background/Aim Traditional risk factors, like impaired transmitral flow in diastolic filling [vortex formation time (VFT) as echocardiographic parameter], contribute to Alzheimer's disease (AD). Moreover, we observed that acetylcholinesterase inhibitors provide a significant cardioprotection. We assessed the pathogenetic role of VFT as early cardiovascular risk factor in 23 AD patients and 24 controls. Results The results showed no statistical difference between the two groups, but the VFT values were significantly lower in nontreated AD patients, and higher value were observed in AD patients treated with anticholinesterases. Conclusions The results support the beneficial effects of anticholinesterases on the cardiovascular system of AD patients. Thus, the transition to evidence-based medicine and an in vivo model of cardiomyocytes might strengthen these results.
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Affiliation(s)
- Fiammetta Monacelli
- Sections of Geriatrics, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
| | - Patrizio Odetti
- Sections of Geriatrics, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
| | - Marina Sartini
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonello Parodi
- Sections of Cardiology, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
| | - Claudio Brunelli
- Sections of Cardiology, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
| | - Gianmarco Rosa
- Sections of Cardiology, Department of Internal Medicine and Medical Specialties (DiMI), Genoa, Italy
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Glodzik L, Randall C, Rusinek H, de Leon MJ. Cerebrovascular reactivity to carbon dioxide in Alzheimer's disease. J Alzheimers Dis 2013; 35:427-40. [PMID: 23478306 DOI: 10.3233/jad-122011] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is growing evidence that cerebrovascular reactivity to carbon dioxide (CVRCO2) is impaired in Alzheimer's disease (AD). Preclinical and animal studies suggest chronic hypercontractility in brain vessels in AD. We review (a) preclinical studies of mechanisms for impaired CVRCO2 in AD; (b) clinical studies of cerebrovascular function in subjects with AD dementia, mild cognitive impairment (MCI), and normal cognition. Although results of clinical studies are inconclusive, an increasing number of reports reveal an impairment of vascular reactivity to carbon dioxide in subjects with AD, and possibly also in MCI. Thus, CVRCO2 may be an attractive means to detect an early vascular dysfunction in subjects at risk.
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Affiliation(s)
- Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
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Valério Romanini C, Dias Fiuza Ferreira E, Correia Bacarin C, Verussa MH, Weffort de Oliveira RM, Milani H. Neurohistological and behavioral changes following the four-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion: comparison between normotensive and spontaneously hypertensive rats. Behav Brain Res 2013; 252:214-21. [PMID: 23727150 DOI: 10.1016/j.bbr.2013.05.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 01/06/2023]
Abstract
Chronic cerebral hypoperfusion (CCH) may be a prodromal feature of aging-related dementias, and chronic hypertension is a major risk factor. We used a permanent, four-vessel occlusion/internal carotid artery (4-VO/ICA) model to evaluate the cognitive and neurohistological outcomes of CCH in both young and middle-aged rats. Young rats are asymptomatic after permanent 4-VO/ICA, and we tested the hypothesis that chronic hypertension aggravates the outcomes of CCH. Young normotensive rats (NTRs) and young spontaneously hypertensive rats (SHRs) were first subjected to 4-VO/ICA and then examined for hippocampal and cortical neurodegeneration 7, 15, and 30 days later. In a second experiment, both NTRs and SHRs were then trained in a modified, non-food-rewarded aversive radial maze (AvRM) task until acquiring asymptotic performance and then subjected to 4-VO/ICA. Thirty days later, they were assessed for memory retention of the previously acquired cognition. In a third, post hoc experiment, middle-aged NTRs were trained in the AvRM, subjected to 4-VO/ICA, and tested for memory retention 30 days later. Compared with NTRs, both SHRs and middle-aged NRTs had severe hippocampal and cortical damage, but they did not differ from each other, regardless of the chronicity of 4-VO/ICA. In contrast, NTRs were behaviorally asymptomatic, and retrograde memory performance was persistently impaired in SHRs. This amnesic effect in the SHR group was very similar to the middle-aged NTR group. These findings suggest that chronic hypertension deteriorates the capacity of the brain to adaptively respond to CCH. This influence of hypertension may parallel the effect of aging.
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Affiliation(s)
- Cássia Valério Romanini
- Department of Pharmacology and Therapeutics, State University of Maringá, Av. Colombo, 5790, Maringá, Paraná, CEP 87020-900, Brazil
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Roher AE, Debbins JP, Malek-Ahmadi M, Chen K, Pipe JG, Maze S, Belden C, Maarouf CL, Thiyyagura P, Mo H, Hunter JM, Kokjohn TA, Walker DG, Kruchowsky JC, Belohlavek M, Sabbagh MN, Beach TG. Cerebral blood flow in Alzheimer's disease. Vasc Health Risk Manag 2012; 8:599-611. [PMID: 23109807 PMCID: PMC3481957 DOI: 10.2147/vhrm.s34874] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Alzheimer’s disease (AD) dementia is a consequence of heterogeneous and complex interactions of age-related neurodegeneration and vascular-associated pathologies. Evidence has accumulated that there is increased atherosclerosis/arteriosclerosis of the intracranial arteries in AD and that this may be additive or synergistic with respect to the generation of hypoxia/ischemia and cognitive dysfunction. The effectiveness of pharmacologic therapies and lifestyle modification in reducing cardiovascular disease has prompted a reconsideration of the roles that cardiovascular disease and cerebrovascular function play in the pathogenesis of dementia. Methods Using two-dimensional phase-contrast magnetic resonance imaging, we quantified cerebral blood flow within the internal carotid, basilar, and middle cerebral arteries in a group of individuals with mild to moderate AD (n = 8) and compared the results with those from a group of age-matched nondemented control (NDC) subjects (n = 9). Clinical and psychometric testing was performed on all individuals, as well as obtaining their magnetic resonance imaging-based hippocampal volumes. Results Our experiments reveal that total cerebral blood flow was 20% lower in the AD group than in the NDC group, and that these values were directly correlated with pulse pressure and cognitive measures. The AD group had a significantly lower pulse pressure (mean AD 48, mean NDC 71; P = 0.0004). A significant group difference was also observed in their hippocampal volumes. Composite z-scores for clinical, psychometric, hippocampal volume, and hemodynamic data differed between the AD and NDC subjects, with values in the former being significantly lower (t = 12.00, df = 1, P = 0.001) than in the latter. Conclusion These results indicate an association between brain hypoperfusion and the dementia of AD. Cardiovascular disease combined with brain hypoperfusion may participate in the pathogenesis/pathophysiology of neurodegenerative diseases. Future longitudinal and larger-scale confirmatory investigations measuring multidomain parameters are warranted.
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Affiliation(s)
- Alex E Roher
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, AZ 85351, USA.
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18
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Sildenafil provides sustained neuroprotection in the absence of learning recovery following the 4-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion in middle-aged rats. Brain Res Bull 2012; 90:58-65. [PMID: 22982173 DOI: 10.1016/j.brainresbull.2012.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/27/2012] [Accepted: 08/30/2012] [Indexed: 12/19/2022]
Abstract
In this study, we tested whether the phosphodiesterase-5 inhibitor sildenafil protects against neurodegeneration and facilitates recovery from learning deficits examined long after chronic cerebral hypoperfusion (CCH) induced by the 4-vessel occlusion/internal carotid artery (4-VO/ICA) model in middle-aged rats. Male Wistar rats (12-15 months of age) were subjected to permanent 3-stage 4-VO/ICA with an interstage interval of 4 days. Sildenafil (3 mg/kg, p.o.) was administered at one dose per day for 10 days, beginning soon after the first occlusion stage. Three months later, learning in a non-food-rewarded, eight-arm radial maze task was tested. Learning performance is expressed as the latency to find a goal box and the number of reference or working memory errors. Histological examination was performed 1-3 days after behavioral testing. In the vehicle-treated group, permanent 4-VO/ICA markedly disrupted learning performance and caused moderate-to-severe neurodegeneration in the CA1-CA4 subfields of the hippocampus (56.2%), dentate gyrus (DG; 19.2%), retrosplenial cortex (RS cortex; 47.4%), and parietal association cortex (PtA cortex; 38.2%). Sildenafil treatment did not prevent 4-VO/ICA-induced learning deficits, whereas neurodegeneration was significantly reduced in the CA1-CA4 subfields (30.5%), DG (7.2%), RS cortex (11.8%), and PtA cortex (6.5%). Advancing previous findings from our laboratory, this study suggests that while sildenafil can provide important neuroprotection in different brain regions of middle-aged rats subjected to CCH, such histological effect does not translate into cognitive recovery.
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Martins Pereira F, Dias Fiuza Ferreira E, Weffort de Oliveira RM, Milani H. Time-course of neurodegeneration and memory impairment following the 4-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion in middle-aged rats. Behav Brain Res 2012; 229:340-8. [DOI: 10.1016/j.bbr.2012.01.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/11/2012] [Indexed: 10/14/2022]
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Abstract
Despite an archive of over 73,000 research papers published in the last two decades on the subject of Alzheimer's disease (AD), little clinical progress has been made relative to how people get sporadic AD and what can be done to help them avoid it. This review spotlights strategic steps that could be a turning point in the dramatic lowering of Alzheimer prevalence. The main strategy includes application of four pillars of prevention: 1) early identification of AD vascular risk factors; 2) early detection of AD vascular risk factors; 3) early intervention of AD vascular risk factors based on evidence-based medical decisions; 4) patient follow-up to assess and modify interventions as needed. Tandem to these four pillars of prevention, a proactive lifestyle consisting of a healthy diet coupled to physical and mental activity should be applied as part of any therapeutic intervention. We are persuaded by mounting and compelling evidence that AD is a multifactorial disorder kindled by vascular risk factors that generate chronic brain hypoperfusion (CBH) during advanced aging. A pathobiological cascade of biochemical events in the presence of CBH that leads to oxidative stress and neurodegeneration appears to involve multiple biofactors including micronutrients, trace metals, lipids, and pro-oxidants, as reviewed in this special issue of BioFactors. Modulation of these biofactors may help prevent or control incipient AD. © 2012 International Union of Biochemistry and Molecular Biology, Inc.
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Affiliation(s)
- Jack C de la Torre
- Department of Psychology, University of Texas at Austin, Austin, TX, USA.
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Ferreira EDF, Romanini CV, Mori MA, de Oliveira RMW, Milani H. Middle-aged, but not young, rats develop cognitive impairment and cortical neurodegeneration following the four-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion. Eur J Neurosci 2011; 34:1131-40. [PMID: 21884555 DOI: 10.1111/j.1460-9568.2011.07824.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Permanent, stepwise occlusion of the vertebral arteries (VAs) and internal carotid arteries (ICAs) following the sequence VA→ICA→ICA, with an interstage interval (ISI, →) of 7 days, has been investigated as a four-vessel occlusion (4-VO)/ICA model of chronic cerebral hypoperfusion. This model has the advantage of not causing retinal damage. In young rats, however, 4-VO/ICA with an ISI of 7 days fails to cause behavioral sequelae. We hypothesized that such a long ISI would allow the brain to efficiently compensate for cerebral hypoperfusion, preventing the occurrence of cognitive impairment and neurodegeneration. The present study evaluated whether brain neurodegeneration and learning/memory deficits can be expressed by reducing the length of the ISI and whether aging influences the outcome. Young, male Wistar rats were subjected to 4-VO/ICA with different ISIs (5, 4, 3 or 2 days). An ISI of 4 days was used in middle-aged rats. Ninety days after 4-VO/ICA, the rats were tested for learning/memory impairment in a modified radial maze and then examined for neurodegeneration of the hippocampus and cerebral cortex. Regardless of the ISI, young rats were not cognitively impaired, although hippocampal damage was evident. Learning/memory deficits and hippocampal and cortical neurodegeneration occurred in middle-aged rats. The data indicate that 4-VO/ICA has no impact on the capacity of young rats to learn the radial maze task, despite 51% hippocampal cell death. Such resistance is lost in middle-aged animals, for which the most extensive neurodegeneration observed in both the hippocampus and cerebral cortex may be responsible.
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Affiliation(s)
- Emilene D Fiuza Ferreira
- Department of Pharmacology and Therapeutic, Health Science Center, State University of Maringá, Av. Colombo 5790, Maringá, Paraná, Brazil
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Monsuez JJ, Gesquière-Dando A, Rivera S. Cardiovascular prevention of cognitive decline. Cardiol Res Pract 2011; 2011:250970. [PMID: 21318115 PMCID: PMC3035018 DOI: 10.4061/2011/250970] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/23/2010] [Indexed: 11/20/2022] Open
Abstract
Midlife cardiovascular risk factors, including diabetes, hypertension, dyslipemia, and an unhealthy lifestyle, have been linked to subsequent incidence, delay of onset, and progression rate of Alzheimer disease and vascular dementia. Conversely, optimal treatment of cardiovascular risk factors prevents and slows down age-related cognitive disorders. The impact of antihypertensive therapy on cognitive outcome in patients with hypertension was assessed in large trials which demonstrated a reduction in progression of MRI white matter hyperintensities, in cognitive decline and in incidence of dementia. Large-scale database correlated statin use and reduction in the incidence of dementia, mainly in patients with documented atherosclerosis, but clinical trials failed to reach similar conclusions.
Whether a multitargeted intervention would substantially improve protection, quality of life, and reduce medical cost expenditures in patients with lower risk profile has not been ascertained. This would require appropriately designed trials targeting large populations and focusing on cognitive decline as a primary outcome endpoint.
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Affiliation(s)
- Jean-Jacques Monsuez
- AP-HP, Hôpital René Muret, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Policlinique Médicale, Avenue du Docteur Schaeffner, 93270 Sevran, France
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de la Torre JC. Vascular risk factor detection and control may prevent Alzheimer's disease. Ageing Res Rev 2010; 9:218-25. [PMID: 20385255 DOI: 10.1016/j.arr.2010.04.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 03/31/2010] [Accepted: 04/01/2010] [Indexed: 01/19/2023]
Abstract
The vascular hypothesis of Alzheimer disease (AD), first proposed by us in 1993, provides substantial evidence that suggests vascular risk factors (VRF) play a critical role in the development of cognitive decline and AD during aging. Cardiovascular and carotid artery disease, two major risk factors to AD, can conspire or independently induce chronic brain hypoperfusion (CBH) decades before any symptoms of cognitive impairment are expressed. The pathologic construct linking CBH to cognitive impairment and AD remains unclear but evidence shows that it may provide an opportunity to intervene in the prevention or delay of dementia onset. A preliminary randomized clinical study in cognitively healthy middle age individuals to undergo screening using carotid Doppler ultrasound, echocardiography and ankle-brachial index is proposed. These office tools are non-invasive, cost-effective, easily applied in one session and relatively accurate procedures with no inherent harmful effects. More importantly, ultrasound can help identify asymptomatic patients most likely to develop progressive cognitive decline due to persistent CBH secondary to progressive cardiovascular or carotid artery pathology. When these VRF are detected within the heart or carotid arteries, optimal medical treatment or management may be indicated to prevent or slow down further disease progression that fosters cognitive deterioration generated from such conditions. Secondary screening tools such as neuroimaging, neurocognitive testing and CSF markers may be used to confirm ultrasound findings. Prevention-by-detection of VRF and target treatment, if found effective, could significantly promote healthier mental and physical aging and lessen the socio-economic calamity anticipated from the growing prevalence of dementia.
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Cerebrovascular and cardiovascular pathology in Alzheimer's disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 84:35-48. [PMID: 19501712 DOI: 10.1016/s0074-7742(09)00403-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Presently, compelling evidence indicates that Alzheimer's disease (AD) is a vascular disorder with neurodegenerative consequences and should be treated as such. A substantial body of evidence including epidemiological, pharmacotherapeutic, and neuroimaging studies support the concept of AD as a vascular disorder or vasocognopathy that initiates as brain hypoperfusion, creating a neuronal energy crisis. The neuronal energy crisis provokes the cellular and molecular changes that characterize this dementia. In this brief review, the many vascular-related risk factors to AD including some that are preventable or amenable to treatment are discussed. Considerable human data now point in a new direction for guiding future research into AD. This new research direction should open a window of opportunity for decisive management and treatment of this devastating disorder.
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