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The overlap between vascular disease and Alzheimer's disease--lessons from pathology

Johannes Attems1, Kurt A Jellinger

  • 1Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK. j.attems@ncl.ac.uk.

BMC Medicine
|November 12, 2014
PubMed

Insights

Cerebrovascular disease (CVD) and Alzheimer's disease (AD) often coexist, accelerating cognitive decline. Early-stage AD combined with cerebrovascular lesions lowers the dementia threshold.

Area of Science:

  • Neurology
  • Pathology
  • Epidemiology

Background:

  • Epidemiological and clinico-pathological data reveal significant overlap between cerebrovascular disease (CVD) and Alzheimer's disease (AD).
  • Cerebral amyloid angiopathy and small vessel disease are common vascular pathologies in aging brains and AD.
  • Up to 84% of aged individuals exhibit morphological signs of CVD alongside AD pathology.

Purpose of the Study:

  • To investigate the additive or synergistic effects of comorbid CVD and AD pathologies on cognitive decline.
  • To examine the impact of different types and severities of CVD on cognitive impairment in AD.

Main Methods:

  • Analysis of epidemiological data and clinico-pathological findings in aging brains and AD patients.
  • Classification of dementia types based on the presence and severity of AD and CVD pathologies.
  • Correlation of specific vascular lesions (subcortical lesions, infarcts) with cognitive status.

Main Results:

  • In advanced AD, small infarcts do not significantly impact cognition due to the overwhelming AD pathology.
  • In early AD stages, cerebrovascular lesions can exacerbate cognitive impairment and lower the threshold for dementia.
  • Mixed dementia (AD + CVD) frequently presents with multiple larger infarcts, unlike pure vascular dementia.

Conclusions:

  • Comorbid CVD and AD have significant, often synergistic, effects on cognitive decline.
  • The impact of CVD on cognitive impairment is stage-dependent in Alzheimer's disease.
  • Further research is needed to fully understand the interplay between CVD and AD in dementia development and progression.

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