P3‐181: Application of a morphologically determined tomography dementia rating scale in the endovascular treatment of dyscirculatory angiopathy of the Alzheimer's type

Abstract

Morphologically determined, objective assessment of disease stage and dementia severity plays an important role in Alzheimer's disease (AD) treatment. Consequently, the Tomography Dementia Rating scale (TDR scale) based on tomographic assessment of brain atrophic changes severity was developed and compared to the Clinical Dementia Rating scale.The research presents results of AD stage evaluation by means of TDR scale before and after DAAT endovascular treatment aimed at restoring microcirculation and brain collateral blood flow by low-energy laser radiation. 46 patients aged 34–79 (average age 65) had been previously observed about AD for a long time. The examination included CT or MRI with subsequent determination of TDR group—SG, SG, REG, and cerebral MUGA.The patients were divided: Group (TDR-0): 4 (8.7%) patients with disease pre-clinical stage, increased risk of AD acquirement (growing memory disorders, without any cognitive impairment or dementia manifestations, immediate relatives suffering from AD)—Temporal lobes atrophy with 4–8 percent tissue mass decrease; Group (TDR-1): 15 (32.6%) patients with mild dementia, mild cognitive impairment—9–18 percent tissue mass atrophic decrease; Group (TDR-2): 20 (43.5%) patients with moderate dementia, persistent cognitive impairment—19–32 percenttissue mass atrophic decrease; Group (TDR-3) 7 (15.2%) patients with severe dementia, gross cognitive impairment—33–48 percent tissue mass atrophic decrease. DAAT was diagnosed among all the patients; endovascular treatment was performed. Endovascular intervention in Group TDR-0 was conducted prophylactically at the patients' request against the growth of memory disorders; in the other groups—in in 1–12 years from AD symptoms appearance. In all the cases the endovascular treatment restored capillary and collateral blood flow and reduced arteriovenous shunts, which then led to atrophic changes decrease, patients' condition improvement, dementia and cognitive impairment level reduction, patients' transfer to earlier TDR Group or out of the scale. The use of morphologically conditioned Tomography Dementia Rating scale allows an easier and more objective evaluation of AD stage determining the severity of cerebral atrophic changes and their dynamics during and after the treatment. Example: Patient T., 61, medical history of AD-6 years. The application of morphologically determined Tomography Dementia Rating scale before and after the endovascular treatment of dyscirculatory angiopathy of Alzheimer's type.