Non-pharmacological therapy and neuroimaging in Alzheimer's disease

Abstract

Non-pharmacological therapy is of current interest in new AD treatments development. We present the results of transcatheter method for AD treatment based on angiogenesis stimulation, revascularization and restoration of brain microvasculature using transluminal impact by low-energy laser radiation. Examination plan: CDR determination, MMSE, CT or MRI with temporal lobes atrophy degree calculation and AD stages determination by «Tomography Dementia Rating scale» (TDR), cerebral scintigraphy (SG), rheoencephalography (REG), cerebral MUGA. Basic cerebral changes at AD were identified: temporal lobes atrophy, along with capillary blood flow reduction in the temporal and fronto-parietal regions, with simultaneous multiple arteriovenous shunts in the same regions, and early venous capillary blood dumping. To stimulate brain angiogenesis and transcatheter revascularization, low-energy laser systems were used. 46 patients were treated, aged 34-79 (average 65), under examination because of AD, of which: Group (TDR-0) - 4 (8.7%) - pre-clinical AD stage without any particular cognitive impairment and dementia manifestations, having 2 or more direct relatives with AD; Group (TDR-1) - 15 (32,6%) - AD history up to 2 years, mild dementia, mild cognitive impairment and mild manifestations of the disease (corresponds to CDR-1); Group (TDR-2) - 20 (43,5%) - AD history up to 6 years, moderate dementia, persistent cognitive impairment and more severe manifestations of the disease (corresponds to CDR-2); Group (TDR-3) - 7 (15.2%) - AD history of 7-12 years, severe dementia, severe cognitive impairment and late stages of the disease (corresponds to CDR-3). Good angiographic outcome manifested in persistent angiogenesis, capillary blood flow restoration and arteriovenous shunts reduction, was obtained in all cases, which in turn led to amyloid beta metabolism normalization in the cerebral tissue. In the long-term (2-6 years), all 46 patients showed 8-15% temporal lobes tissue mass growth accompanied by dementia level decrease and cognitive functions improvement. All patients were transferred to earlier TDR groups or withdrawn from the scale. According to cerebral MUGA, all 8 (17.39%) re-examined patients had further angiogenesis progression. The proposed non-pharmacological treatment promotes amyloid beta elimination, suspends AD progression or even cause its regression, furthering cerebral tissue regeneration. Patient A., 56 years old. Left internal carotid artery angiogram, side view, arterial phase. Prior to the transcatheter treatment; Hypovascular area in the fronto-parietal and temporal region. Same patient A., 56 years old. Left internal carotid artery angiogram, side view, arterial phase. After the transcatheter treatment; Restoration of capillary blood supply in the fronto-parietal and temporal regions.