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Published on: April 14, 2014
Vascular dysfunction-The disregarded partner of Alzheimer's disease
Melanie D Sweeney1, Axel Montagne1, Abhay P Sagare1
1Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Insights
Alzheimer
Area of Science:
- Neurology
- Neuroimaging
- Vascular Biology
Background:
- Alzheimer's disease (AD) is increasingly recognized as a complex, multifactorial condition.
- Vascular dysfunction is a significant, early contributor to AD pathophysiology.
- The current AD Research Framework focuses on amyloid, tau, and neuronal injury.
Purpose of the Study:
- To highlight the role of vascular dysfunction in Alzheimer's disease.
- To propose the integration of vascular imaging biomarkers into the AD Research Framework.
- To improve understanding and treatment of AD by incorporating vascular factors.
Main Methods:
- Review of evidence linking vascular dysfunction to AD.
- Examination of neuroimaging techniques for assessing vascular changes (e.g., blood-brain barrier integrity, cerebral blood flow).
- Discussion of established vascular imaging biomarkers for small vessel disease.
Main Results:
- Vascular dysfunction is an early and critical component of AD.
- Neuroimaging can effectively evaluate vascular contributions to AD.
- Existing biomarkers for small vessel disease are well-characterized and readily applicable.
Conclusions:
- Vascular factors are crucial for a comprehensive understanding of Alzheimer's disease.
- Incorporating vascular imaging biomarkers into the AD Research Framework is recommended.
- This integration can enhance AD diagnosis, treatment, and research efforts.
Abstract:
Increasing evidence recognizes Alzheimer's disease (AD) as a multifactorial and heterogeneous disease with multiple contributors to its pathophysiology, including vascular dysfunction. The recently updated AD Research Framework put forth by the National Institute on Aging-Alzheimer's Association describes a biomarker-based pathologic definition of AD focused on amyloid, tau, and neuronal injury. In response to this article, here we first discussed evidence that vascular dysfunction is an important early event in AD pathophysiology. Next, we examined various imaging sequences that could be easily implemented to evaluate different types of vascular dysfunction associated with, and/or contributing to, AD pathophysiology, including changes in blood-brain barrier integrity and cerebral blood flow. Vascular imaging biomarkers of small vessel disease of the brain, which is responsible for >50% of dementia worldwide, including AD, are already established, well characterized, and easy to recognize. We suggest that these vascular biomarkers should be incorporated into the AD Research Framework to gain a better understanding of AD pathophysiology and aid in treatment efforts.
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