Cerebrovascular pathology in Alzheimer's disease: Hopes and gaps
1NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montréal, QC, Canada; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Insights
This study proposes adding a vascular (V) category to the Alzheimer
Area of Science:
- Neurology and Neuroscience
- Medical Imaging
- Cardiovascular Health
Background:
- Alzheimer's disease (AD) is a complex, multifactorial condition with vascular dysfunction as a key contributor.
- Current diagnostic frameworks for AD may not fully capture the impact of vascular factors.
- Revisions to the existing AT(N) classification are anticipated, presenting an opportunity for enhancement.
Purpose of the Study:
- To advocate for the inclusion of a vascular (V) category within the AT(N) classification system for Alzheimer's disease.
- To identify and evaluate current vascular markers and risk factors suitable for integration into AD diagnostic frameworks.
- To emphasize the benefits of a comprehensive classification for personalized AD treatment strategies.
Main Methods:
- Review and discussion of established vascular MRI markers: lacunes, white matter hyperintensities, and microbleeds (visible on Flair, T2* weighted, and SWI).
- Exploration of advanced imaging techniques, including diffusion-based metrics and perfusion sequences, for detecting subtle vascular changes.
- Analysis of critical cardiovascular risk factors: hypertension history, obesity, and diabetes.
Main Results:
- Specific vascular MRI findings (lacunes, white matter hyperintensities, microbleeds) are identified as ready for inclusion.
- Advanced imaging modalities offer potential for detecting more nuanced vascular pathologies.
- Key cardiovascular risk factors (hypertension, obesity, diabetes) are highlighted as crucial additions to AD assessment.
Conclusions:
- Integrating a vascular (V) category into the AT(N) framework will significantly improve AD classification.
- This enhanced classification will facilitate targeted therapeutic interventions for specific AD patient subgroups.
- The proposed framework supports precision medicine approaches in managing Alzheimer's disease.
Abstract:
Alzheimer's disease (AD) is recognized as multifactorial and heterogeneous disease with multiple contributors to its pathophysiology, including vascular dysfunction. Given that a revision of the AT(N) classification is expected in the near future, the present work supports the importance to add an additional vascular (V) category to the framework. In particular, we attempt to shed light on the vascular markers and risk factors that are currently ready-to-be-added to the framework: i) lacunes, ii) white matter hyperintensities and iii) microbleeds seen in Flair, T2* weighted imaging and susceptibility images (SWI). Next, we discuss the added value of other types of imaging, such as diffusion-based metrics and advanced perfusion sequences to encompass more subtle vascular dysfunction. Finally, we highlight the importance to add information about the following cardiovascular risk factors to the framework: history of hypertension, obesity, and diabetes. We believe that adding a V category to the AT(N) framework will improve AD classification and foster efforts to apply the right drug(s) at the right time in the right AD subgroups. Brief communication The present work supports the importance to add an additional vascular (V) category to the AT(N) framework and shed light on the vascular MRI markers and risk factors that are currently ready-to-be-added to the framework.
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