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Published on: November 22, 2024
A vascular approach to mild amnestic cognitive impairment: a pilot study
A Fromm1, A J Lundervold, G Moen
1Department of Neurology, Haukeland University Hospital, Bergen, Norway. annette.fromm@helse-bergen.no
Objective:
Mild cognitive impairment (MCI) is a subtle memory disorder not matching criteria for dementia. There is evidence for vascular comorbidity in several types of dementia. We hypothesized that neurovascular workup would detect a high degree of vascular disease in patients with MCI.
Materials And Methods:
In cooperation with our memory clinic, patients with amnestic MCI were referred to our department for neurovascular investigation. The workup encompassed ultrasound examination with carotid duplex including Intima-Media-Thickness (IMT) measurement, and transcranial Doppler (TCD) including one-hour microemboli monitoring, cerebrovascular reactivity measurement and Bubble test. Cerebral MRI for the evaluation of vascular and white-matter lesions, brain atrophy, hippocampal volumes, and amyloid angiopathy was performed.
Results:
Ten patients were included. Vascular risk factors were present in six patients. Four patients had atherosclerotic lesions, three classified as mild, and one as moderate carotid stenosis. IMT > 1 mm was found in two patients, with a maximum IMT of 1.11 mm. None of the patients with acceptable bone window had intracranial stenosis in TCD. Vasoreactivity was pathologically low in one patient. Permanent right-left shunt was found in three patients, of which one showed spontaneous cerebral microembolism. Hippocampal volume reduction and cortical atrophy were found in four patients. Chronic ischemic changes in MRI were present in one patient, and three patients had subcortical infarctions. Cortical infarctions, microbleeds, or amyloid angiopathy were not found.
Conclusions:
Pure amnestic MCI is probably less associated with cerebrovascular disease and may be more consistent with evolving Alzheimer's disease. However, vascular risk factors are common in these patients.
Insights
This study investigated cerebrovascular disease in mild cognitive impairment (MCI). Findings suggest pure amnestic MCI is less linked to vascular issues, potentially indicating early Alzheimer's disease, though vascular risks remain common.
Area of Science:
- Neurology
- Vascular Medicine
- Neuroimaging
Background:
- Mild cognitive impairment (MCI) is a precursor to dementia, with vascular factors implicated in some dementia types.
- Understanding the role of cerebrovascular disease in MCI is crucial for diagnosis and treatment.
Purpose of the Study:
- To investigate the prevalence of cerebrovascular disease in patients with amnestic MCI using comprehensive neurovascular assessments.
- To determine if neurovascular workup reveals significant vascular pathology in MCI patients.
Main Methods:
- Patients with amnestic MCI underwent carotid duplex ultrasound (including Intima-Media Thickness), transcranial Doppler (TCD) with microemboli monitoring, and cerebrovascular reactivity tests.
- Cerebral MRI evaluated vascular lesions, white-matter changes, brain atrophy, hippocampal volumes, and amyloid angiopathy.
Main Results:
- Six of ten patients had vascular risk factors; four had carotid stenosis (mild to moderate).
- Two patients showed increased Intima-Media Thickness (>1 mm).
- Three patients had right-left shunts, one with microembolism; one patient had low vasoreactivity. MRI revealed atrophy in four patients and ischemic changes in three.
Conclusions:
- Pure amnestic MCI appears less associated with cerebrovascular disease, possibly indicating early Alzheimer's disease.
- Despite low direct vascular findings, vascular risk factors are prevalent in this MCI cohort.
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