Hematologic risk factors of vascular disease and their relation to dementia

Comparative pharmacokinetic study of the components of Jia-Wei-Kai-Xin-San in normal and vascular dementia rats by ultra-fast liquid chromatography coupled with tandem mass spectrometry

A fast, sensitive, and reliable ultra-high performance liquid chromatography coupled with tandem mass spectrometry method has been developed and validated for simultaneous quantification of geniposide, polygalaxanthone III, 3,6'-disinapoyl sucrose, α-asarone, β-asarone, poricoic acid A, poricoic acid B, dehydrotumulosic acid, deoxyschizandrin, schizandrin B, and kaempferide in plasma after oral administration of extracts of Jia-Wei-Kai-Xin-San in normal and vascular dementia rats. The developed method was precise and accurate within the linearity range of the analytes. The lower limits of quantification were 1.04-2.68 ng/mL for all the analytes. Both intra- and inter day precision and accuracy of the analytes were all within accepted criteria. The mean extraction recoveries of the analytes and the internal standard from rat plasma were all >60.0%. The validated method had been successfully applied to compare pharmacokinetic profiles of the analytes in plasma of normal and vascular dementia rat treated with herbal extracts. Results indicated that differences existed between normal and vascular dementia model rats except dehydrotumulosic acid and kaempferide, which might be due to the pathology of vascular dementia and pharmacological effect of the analytes. These pharmacokinetic studies might benefit for the mechanism exploration and clinical use of traditional Chinese medicine formulae.

Risk factors for dementia with type 2 diabetes mellitus among elderly people in China

OBJECTIVE

to investigate the prevalence and risk factors of diabetes to dementia and its subtypes such as Alzheimer disease (AD) and vascular dementia (VD) among the Chinese elderly population.

METHODS

among 8,213 Chinese people aged 65 years and older, 1,109 subjects with type 2 diabetes millitus (T2DM) were ascertained by interview and direct glucose testing. All diabetic subjects were initially screened with the "DSM-IV criteria" for dementia and its subtypes. We compared the prevalence of dementia in diabetic patients with that in ordinary subjects, and analyzed the association of the status of diabetes with dementia including AD and VD. Logistic regression was used to assess OR of dementia and its subtypes with T2DM.

RESULTS

after a comprehensive geriatric and cognitive assessment, 132 diabetic subjects were diagnosed with all-cause dementia. The prevalence rate for dementia with T2DM was 1.61%. Of demented subjects, 37 subjects had AD, 30 subjects had VD. The prevalence rates for AD with T2DM and VD with T2DM were 4.51% and 3.65%, respectively. In the univariate analyses, among all diabetic subjects, compared with cognitive intactly subjects, the demented subjects, including AD and VD subjects, were older, more female had higher percentage of current smoking, had a greater duration of diabetes, took more frequent use of diabetes medications, and stronger effect of APOE ε4 status. In multivariate logistic regression analyses, variables including age, APOE ε4 allele, duration from onset of diabetes, using oral hypoglycemic agents, HMG-CoA reductase (statins) were significantly associated with increased risk for dementia with T2DM (all P < 0.05).

CONCLUSIONS

the present study shows that T2DM is associated with dementia and its subtypes amongst elderly people in the Chinese population.

Plasma viscosity: is a biomarker for the differential diagnosis of Alzheimer's disease and vascular dementia?

In this study, the importance of plasma viscosity (PV) as a biomarker in differential diagnosis of dementia subtypes especially Alzheimer's disease (AD) and vascular dementia (VaD) was investigated. Our study recruited 45 patients with AD, 35 patients with VaD, and control participants. Individuals with inflammatory disease, infection, heart, liver, renal failure, and with high erythrocyte sedimentation rate and C-reactive protein levels were excluded from the study. The cases underwent comprehensive geriatric assessment. The PV measurements were performed with Brookfield DV-II viscometer. The PV measurements of AD, VaD, and control groups were 1.61 ± 0.08, 1.70 ± 0.06, and 1.48 ± 0.06 mPa S, respectively. The PV levels of the dementia group were significantly higher than the control group (P < .001). When the dementia group was analyzed by itself, patients with VaD had higher PV levels than the patients with AD (P < .001). The PV is a biomarker to be used in diagnosis as well as in differentiating between the 2 most common forms of dementia which are AD and VaD.

Plasma homocysteine, brain imaging and cognition in older patients with mental illness

BACKGROUND

Total plasma homocysteine (tHcy) concentration is elevated in older patients with mental illness, and patients with vascular disease have higher plasma tHcy concentration than patients without vascular disease. Plasma tHcy has been reported to be associated with cognitive functions. The mechanism by which plasma tHcy may influence cognitive functions is not clear.

METHOD

We have investigated the relation between plasma tHcy, brain imaging findings (computer tomography scan [CT]) and cognition, measured as Mini mental state examination (MMSE), in 395 consecutively enrolled older patients with mental illness.

RESULTS

Age and plasma tHcy were significant predictors of MMSE score, whereas pathological CT findings, indicating cerebrovascular disease, showed no prediction of MMSE score.

CONCLUSION

The relation between plasma tHcy and cognition is not mediated by cerebrovascular disease as evaluated by pathological CT findings.

The use of N-terminal pro-brain natriuretic Peptide to evaluate vascular disease in elderly patients with mental illness

Background

Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) is regarded as a sensitive marker of cardiovascular disease. Vascular disease plays an important role in cognitive impairment.

Method

In 447 elderly patients with mental illness, serum NT-proBNP level and the presence or absence of vascular disease according to the medical record were used to categorize patients in different subgroups of vascular disease.

Results and Conclusion

Patients with vascular disease and elevated serum NT-proBNP level had a lower cognition level, shorter survival time, lower renal function and a higher percentage of pathological brain imaging than patients with vascular disease and normal NT-proBNP level. Thus, elevated serum NT-proBNP level might be helpful to detect patients who have a more severe cardiovascular disease.

The clinical use of N-terminal-pro brain natriuretic peptide in elderly patients with mental illness

BACKGROUND

Serum N-terminal-pro brain natriuretic peptide (NT-proBNP) is regarded as a marker of vascular disease and has previously been shown to exhibit an increased frequency of pathological values in elderly patients with mental illness with vascular disease compared to patients without vascular disease. Vascular disease plays an important role in cognitive impairment in elderly patients with mental illness.

METHOD

We have investigated the relation between NT-proBNP, vascular disease and cognition in consecutively enrolled elderly patients with mental illness.

RESULTS

NT-proBNP level is increased in patients with vascular disease compared to patients without vascular disease, and a logistic regression analysis showed that NT-proBNP was a significant predictor of vascular disease. However, NT-proBNP level did not predict cognition as assessed by MMSE score. NT-proBNP level also showed a highly significant relation to mortality in all patients.

CONCLUSION

Determinations of NT-proBNP could be used in elderly patients with mental illness to detect patients in need of control and treatment of vascular risk factors. The levels of NT-proBNP may also provide prognostic information.

Plasma homocysteine, apolipoprotein E status and vascular disease in elderly patients with mental illness

BACKGROUND

Total plasma homocysteine (tHcy) concentration is increased in elderly patients with mental illness. Also, patients with vascular disease have significantly higher plasma tHcy concentration compared with patients without vascular disease. Apolipoprotein E (apoE) status is associated with cardiovascular disease and a major genetic risk factor is inheritance of the e4 allele. In the present study, we investigated the association between plasma tHcy and apoE status.

METHODS

The relation between apoE status, plasma tHcy and vascular disease was investigated in a cohort of consecutively enrolled elderly patients with mental illness (n=328).

RESULTS

Plasma tHcy concentrations were increased (p<0.01) in carriers of APOE4 (13.6 micromol/L; 9.2-21.7 micromol/L) compared to non-carriers (12.4 micromol/L; 8.3-19.9 micromol/L). The proportion of patients with vascular disease was significantly (p<0.001) increased among carriers (61%) compared to non-carriers (42%). An increased percentage (p<0.001) of APOE4 carriers was observed in patients with Alzheimer's disease (AD) with (71%) or without vascular disease (42%), and in patients with vascular dementia (VaD) (54%) compared to a reference group (34%).

CONCLUSIONS

Since carriers of APOE4 showed an increased likelihood of vascular disease, these patients need more intensive control of other modifiable vascular risk factors. Furthermore, the association between plasma tHcy and the presence of APOE4 might be attributed to an increased proportion of vascular disease in APOE4 carriers.

Vascular factors and prevention of dementia

The identification of modifiable risk factors that prevent dementia or slow its progression is a major public health priority. Vascular disease and its risk factors have been linked with cognitive decline and dementia, although the degree of association varies depending on differences in vulnerability related to age, ethnicity, disease co-morbidity and possibly brain reserve. Here we review current dementia prevention strategies linked to vascular modification to identify whether any approach exists that will reduce the population burden of dementia, and whether any exist that show evidence of being cost effective and safe for populations. As yet, there is no compelling evidence that dementia can be prevented through vascular manipulation by pharmacological or non-pharmacological trials. To date, no intervention can be recommended for dementia prevention at the population level including Alzheimer's Disease or Vascular Dementia. Advances in the prevention of dementia will be gained, it is argued, from a more complete understanding of the pathophysiology of disease and its causes, particularly in early life, within and across different populations and age groups. Furthermore, a more complete understanding of the earliest pre-clinical stage of disease is required for effective risk factor modification. Although the current state of knowledge cannot support public health policy for vascular manipulation for dementia prevention at the population level, this does not undermine the importance of vascular manipulation in its own right to promote healthier ageing.

Homocysteine, cystatin C and N-terminal-pro brain natriuretic Peptide. Vascular risk markers in elderly patients with mental illness

BACKGROUND

There is increasing evidence that vascular disease contributes to cognitive impairment and dementia. Clarification of the role of vascular risk factors in dementia is important because most are modifiable, in contrast to other risk factors such as age and genetics.

METHODS

In 451 patients with mental illness we have investigated three biochemical markers related to vascular disease, total plasma homocysteine (tHcy), cystatin C, and N-terminal-pro brain natriuretic peptide (NT-proBNP), and their association with vascular disease, diagnoses, and brain imaging findings (CT).

RESULTS

Plasma tHcy, serum cystatin C, and serum NT-proBNP showed significantly increased frequencies of elevated levels in patients with vascular disease, in patients with a pathological CT finding indicating cerebrovascular disease, and in patients above 75 years of age.

CONCLUSION

It is possible that the control of conventional vascular risk factors and therapy could be guided by the level of plasma tHcy, serum cystatin C, and serum NT-proBNP. Patients with an elevation of any of these three parameters could be selected for a lower target level of risk factors such as blood pressure, hyperlipidemia etc. than conventional target levels.

Risk factors and type of dementia: vascular or Alzheimer?

The most efficient strategy for combating Alzheimer's disease (AD) is to prevent the onset of clinically significant symptoms. Determining the clinical characteristics, risk factors, and indices of cognitive reserve would help in achieving this goal. The aim of this study was to determine the risk factors for AD and vascular dementia (VD) in the elderly and to highlight the importance of risk factor modification in the early diagnosis. Consecutive 1436 patients (mean age=72.7+/-6.9 years, 34.2% male) were enrolled in the study. After a comprehensive geriatric and cognitive assessment, patients were grouped as AD group (n=203), VD group (n=73) and normal cognitive status (NCS) group (n=1160). Thirty-three possibly related factors including demographic characteristics, co-existing diseases and laboratory parameters were examined. The results revealed that female sex, advanced age, depression, and intake of vitamin supplements were independent related factors for AD; whereas depression and low-density lipoprotein-cholesterol (LDL-C) were independent related factors for VD. For every geriatric patient admitted for any reason, cognitive assessment should be performed, risk factors should be determined and the patients at high risk should be followed up carefully.