Cerebrovascular Changes and Cerebral Atrophy in the Development of Dementia during Alzheimer's Disease

Main Article Content

Ivan V. Maksimovich

Abstract

Background: Alzheimer's disease (AD) is the world's number one cerebral neurodegenerative disease. Up to 80% of all dementia cases are due to this disease. AD occurs not only because of impaired metabolism of amyloid beta (Aβ) and tau protein in cerebral tissue, but also in connection with specific disorders of cerebral blood supply, manifested in dyscirculatory angiopathy of Alzheimer's type (DAAT).


Aims: The present research focuses on the clinical discovery of the sequence of development of dyscirculatory angiopathy of Alzheimer's type, cerebral atrophy, and dementia in patients with AD and their immediate family members.


Methods: 99 patients were selected for the research, of whom:


Test Group 1


93 (93.94%) suffered from various stages of AD and severity of dementia (age 34-79 (mean age 67): 32 (34.40%) men, 61 (65.59%) women).


Test Group 2


6 (6.06%) children aged 8-12 with a high probability of inheriting AD. Each of them had a parent diagnosed with AD with mild dementia (TDR-1), and a grandparent diagnosed with AD with moderate (TDR-2) or severe dementia (TDR-3). Each child complained of fatigue, memory loss, difficulty in remembering, difficulty in concentrating, and frequent headaches.


Results:


Test Group 1. According to the severity of dementia and atrophic changes in the temporal lobes, the patients were subdivided: preclinical stage TDR-0 - 10 (10.75%) people, mild stage AD TDR-1 - 26 (27.96%) people, moderately severe stage AD TDR-2-40 (43.01%) people, severe AD TDR-3 - 17 (18.28%) people. We identified dyscirculatory angiopathy of Alzheimer's type in all patients, regardless of their AD stage.


Test Group 2. There were no signs of dementia of cognitive disorders in any case. Initial involutive cerebral changes were detected in all 6 (100%) patients. Phenomena similar to DAAT were detected in all 6 (100%) patients.


Conclusion: Cerebrovascular changes manifested by dyscirculatory angiopathy of Alzheimer's type, regardless of the stage of the disease, are observed in all patients with AD, as well as in all their young offspring.


These changes affect amyloid beta metabolism in the brain and contribute to its deposition and accumulation in cerebral tissue, which leads to neurodegeneration and AD development.


The data obtained indicate that dyscirculatory angiopathy of Alzheimer's type is primary and, moreover, possibly congenital in AD development.

Keywords: Alzheimer's Disease, AD, Dyscirculatory angiopathy of Alzheimer's type, DAAT, CSVD, The Tomography Dementia Rating scale, TDR

Article Details

How to Cite
MAKSIMOVICH, Ivan V.. Cerebrovascular Changes and Cerebral Atrophy in the Development of Dementia during Alzheimer's Disease. Medical Research Archives, [S.l.], v. 11, n. 5, may 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3869>. Date accessed: 27 apr. 2024. doi: https://doi.org/10.18103/mra.v11i5.3869.
Section
Research Articles

References

1. 2022 Alzheimer’s disease facts and figures. Journal of Alzheimer’s & Dementia. 2022; 18 (4) :700-789. https://doi.org/10.1002/alz.12638
2. Waldemar, G., Dubois, B., Emre, M., Georges, J. et al. Recommendations for the diagnosis and management of Alzheimer’s disease and other disorders associated with dementia: EFNS guideline. European Journal of Neurology 2007, 14 (1) e1-26. https://doi.org/10.1111/j.1468-1331.2006.01605.x
3. Burton EJ, Barber R, Mukaetova-Ladinska EB, et al. Medial temporal lobe atrophy on MRI differentiates Alzheimer's disease from dementia with Lewy bodies and vascular cognitive impairment: a prospective study with pathological verification of diagnosis. Brain. 2009; 132 (1): 195-203. https://doi.org/10.1093/brain/awn298
4. Maksimovich IV. Radiodiagnostics of Alzheimer’s disease. Diagnostics and Intervention Radiology. 2008; 2 (4): 27-38. https://doi.org/10.25512/DIR.2008.02.4.04
5. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010; 9, (7): 689–701. https://doi.org/10.1016/S1474-4422(10)70104-6
6. Cai Z, Wang C, He W et al. Cerebral small vessel disease and Alzheimer's disease. Clin Interv Aging. 2015; 23 (10): 1695-1704. https://doi.org/10.2147/CIA.S90871
7. Maksimovich IV. Dyscirculatory Angiopathy of Alzheimer’s Type. Journal of Behavioral and Brain Science. 2011; 1 (2): 57-68. DOI: 10.4236/jbbs.2011.12008
8. Maksimovich IV. Certain new aspects of etiology and pathogenesis of Alzheimer’s disease. Advances in Alzheimer’s Disease. 2012; 1 (3): 68-76. DOI: 10.4236/aad.2012.13009
9. Gjulev NM, Pustozertsev VG, Gjulev SN. Cerebrovascular Diseases. Moscow BINOM, 2002.
10. Richetin K, Steullet P, Pachoud M et al. Tau accumulation in astrocytes of the dentate gyrus induces neuronal dysfunction and memory deficits in Alzheimer’s disease. Nature Neuroscience. 2020; 23:1567-1579. doi: 10.1038/s41593-020-00728-x
11. Kalaria R. Small vessel disease and Alzheimer’s dementia: Pathological considerations. Cerebrovascular Diseases. 2002; 13: 48-52. https://doi.org/10.1159/000049150
12. Iadecola C. The overlap between neurodegenerative and vascular factors in the pathogenesis of dementia. Acta Neuropatho 2010; 120 (3): 287-396. DOI: 10.1007/s00401-010-0718-6.
13. Zlokovic BV. Neurodegeneration and the neurovascular unit. Nat Med 2010; 16 (12): 1370-1371. DOI: 10.1038/nm1210-1370
14. De la Torre JC. Cerebral Perfusion Enhancing Interventions: A New Strategy for the Prevention of Alzheimer Dementia. Brain Pathology 2016; 26 (5): 618–631. https://doi.org/10.1111/bpa.12405
15. Baloiannis SJ and Baloiannis IS. The vascular factor in Alzheimer’s disease: A study in Golgi technique and electron microscopy. Journal of the Neurological Sciences. 2012: 322 (1-2): 117-121. https://doi.org/10.1016/j.jns.2012.07.010
16. Maksimovich IV. Vascular factors in Alzheimer’s disease. Health. 2012; 4, Special Issue (1): 735-742.
DOI: 10.4236/health.2012.429114
17. Nelson AR, Sweeney MD, Sagare AP, Zlokovic BV. Neurovascular dysfunction and neurodegeneration in dementia and Alzheimer's disease. Biochim Biophys Acta. 2016; 1862, (5): 887-900. https://doi.org/10.1016/j.bbadis.2015.12.016
18. Maksimovich IV. Differences in Cerebral Angioarchitectonics in Alzheimer’s Disease in Comparison with Other Neurodegenerative and Ischemic Lesions. World Journal of Neuroscience. 2018; 8, (4): 454-469. DOI: 10.4236/wjns.2018.84036.
19. Maksimovich IV. Transcatheter intracerebral photobiomodulation in degenerative brain disorders: clinical studies (Part 1). In Photobiomodulation in the Brain, Edited by Michael R. Hamblin, Ying-Ying Huang. Academic Press is an imprint of Elsevier, London, 2019; p-p. 515-528 https://doi.org/10.1016/B978-0-12-815305-5.00038-5
20. Maksimovich IV. Transcatheter Intracerebral Laser Photobiomodulation Therapy Reduces Dementia and Cognitive Impairment in Patients with Various Stages of Alzheimer's disease. Medical Research Archives. 2022; 10 (7): 1-15. https://doi.org/10.18103/mra.v10i7.2938
21. Baloyannis, S.J. 2015. Brain capillaries in Alzheimer's disease. Hell J Nucl Med 18, Suppl 1 152.
22. Grammas P, Martinez J, Sanchez A, et al. A new paradigm for the treatment of Alzheimer's disease: targeting vascular activation. J Alzheimers Dis 2014; 40, 3: 619-630. DOI: 10.3233/JAD-2014-132057
23. Bell RD & Zlokovic BV. Neurovascular mechanisms and blood-brain barrier disorder in Alzheimer’s disease. Acta Neuropathologica 2009; 118: 103-113. DOI: 10.1007/s00401-009-0522-3
24. Koike MA, Green KN, Blurton-Jones M, . Oligemic hypoperfusion differentially affects tau and amyloid-{beta}. Am J Pathol. 2010; 177: 300–310. https://doi.org/10.2353/ajpath.2010.090750
25. Love S, Miners JS. Cerebral Hypoperfusion and the Energy Deficit in Alzheimer's Disease. Brain Pathology. 2016; 26 (5): 607–617. https://doi.org/10.1111/bpa.12401
26. Zlokovic BV. Neurovascular pathways to neurodegeneration in Alzheimer’s disease and other disorders. Nature Reviews. Neuroscience. 2011; 12, 723-738. DOI: 10.1038/nrn3114
27. Cortes-Canteli M , Iadecola C. Alzheimer's Disease and Vascular Aging: JACC Focus Seminar. J Am Coll Cardiol. 2020; 3, 75 (8) : 942-951. https://doi.org/10.1016/j.jacc.2019.10.062
28. Kimbrough IF, Robel S, Roberson ED, Sontheimer H. Vascular amyloidosis impairs the gliovascular unit in a mouse model of Alzheimer's disease. Brain. 2015; 138 (12): 3716-3733. https://doi.org/10.1093/brain/awv327
29. Maksimovich IV, and Gotman LN. Method of complex radiation diagnostics at preclinical and clinical stages of Alzheimer’s disease. Russian Patent, No. 2315559. 2006.
30. Maksimovich IV. The tomography dementia rating scale (TDR) - The rating scale of Alzheimer’s disease stages. Health. 2012; 4 (9A):712-719. DOI: 10.4236/health.2012.429111
31. Morris JC. The Clinical Dementia Rating (CDR): Current Version and Scoring Rules. Neurology. 1993; 11 (43): 2412-2414. https://n.neurology.org/content/43/11/2412.2
32. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12 (3): 189-198. https://doi.org/10.1016/0022-3956(75)90026-6
33. Grodstein F, Leurgans SE, Capuano AW, Schneider JA, Bennett DA. Trends in Postmortem Neurodegenerative and Cerebrovascular Neuropathologies Over 25 Years. JAMA Neurol. Published online February 20 2023
DOI: 10.1001/jamaneurol.2022.5416