Abstract
Cerebrovascular disease and AD pathology co-exist in most dementia cases, and microinfarcts (MIs), particularly if cortical and multiple, play an additive and independent role in AD cognitive impairment. The main cause of cortical MIs is chronic cerebral hypoperfusion but occlusive vascular diseases, embolism and blood-brain barrier disruptions, isolated or combined, may also play a role. The precise mechanisms by which MIs cause cognitive impairment are not well known, but one plausible explanation is that they are widespread and accompanied by diffuse hypoperfusion, hypoxia, oxidative stress and inflammation, particularly in the watershed areas of the tertiary association cortex, and hence could damage cognition networks and explain many of AD's cognitive and behavioral disturbances. Therefore, it is crucial to control vascular risk factors and avoid uncontrolled use of the antihypertensives, neuroleptics and other sedative drugs frequently prescribed to AD patients.
Highlights
Cerebrovascular disease (CVD) is the second most common cause of cognitive impairment and dementia in the elderly, after Alzheimer’s disease
The aim of this article was to review the literature focusing on the relationship between microinfarcts (MIs) and Alzheimer’s dementia, given the additive and independent role they play in Alzheimer’s disease (AD) cognitive impairment, even in the 15% of cases without macroinfarcts, lacunes, atherosclerosis, or cerebral amyloid angiopathy (CAA).[14]
The selective distribution of cortical MIs in watershed cortical areas, even in the 15% of AD cases without atherosclerosis and CAA, indicates that their main cause is cerebral hypoperfusion, which may be exacerbated by the use of antihypertensives, neuroleptics and other sedative drugs frequently prescribed to AD patients.[14,25]
Summary
Cerebrovascular disease (CVD) is the second most common cause of cognitive impairment and dementia in the elderly, after Alzheimer’s disease. According to Di Legge & Hachinski,[1] the concept of VCI refers to any cognitive impairment caused or associated with vascular risk factors, and includes the link between CVD and Alzheimer’s disease (AD). VCI and AD have a mixed etiology and share common risk factors for cognitive impairment, such as hypertension, diabetes mellitus, atherosclerotic disease, inflammation, and atrial fibrillation,[2,3,4] the possibility to prevent both diseases. CVD and AD share common elements: [1] stroke may precede, trigger, co-exist, or exacerbate AD-type cognitive impairment; and [2] AD-associated cerebral amyloid angiopathy (CAA) impairs blood vessel function and can cause brain ischemia and cognitive impairment independent of stroke (see Greenberg et al.).[5].
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