The Role of Vascular Risk Factors in Biomarker-Based AT(N) Groups: A German-Dutch Memory Clinic Study
Domantė Kučikienė1, Ana Sofia Costa1,2,3, Leonie C P Banning4
1Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany.
Insights
Vascular risk factors are common in patients with memory problems, with different factors linked to Alzheimer's disease (AD) biomarkers. Understanding these links aids in preventing and treating dementia.
Area of Science:
- Neurology
- Gerontology
- Cardiology
Background:
- The relationship between vascular risk factors (VRFs) and Alzheimer's disease (AD) is critical due to potential pathophysiological links.
- Investigating VRFs in relation to AD biomarkers is essential for understanding disease progression and developing targeted interventions.
Purpose of the Study:
- To determine the prevalence of VRFs within biomarker-defined Alzheimer's disease (AD) continuum groups.
- To explore associations between VRFs, AD cerebrospinal fluid (CSF) biomarkers, brain magnetic resonance imaging (MRI) findings, and cognitive function.
Main Methods:
- Analysis of 838 participants from memory clinics, categorized into normal AD biomarkers, non-AD change, or AD continuum groups based on CSF and MRI data.
- Assessment of demographics, VRFs, CSF AD biomarkers (amyloid-A, tau-T), and MRI for neurodegeneration (N).
- Regression models adjusted for age, sex, and study site.
Main Results:
- Smoking, hypertension, and dyslipidemia were the most prevalent VRFs. Specific VRFs like alcohol abuse and smoking were more common in the non-AD group, while coronary heart disease and carotid artery stenosis were frequent in the AD continuum.
- Parietal atrophy and microbleeds were characteristic of the AD continuum. Carotid artery stenosis correlated with elevated Aβ42 and T-tau levels.
- Diabetes and alcohol abuse were associated with greater medial temporal atrophy and atrial fibrillation, alongside poorer cognitive performance.
Conclusions:
- Vascular risk factors are highly prevalent in memory clinic patients and exhibit distinct patterns across different AD biomarker profiles.
- These findings underscore the importance of considering VRFs for the prevention and personalized treatment strategies in dementia care.
Background:
The relation between vascular risk factors (VRFs) and Alzheimer's disease (AD) is important due to possible pathophysiological association.
Objective:
To assess the prevalence of VRFs in biomarker-based AT(N) groups and the associations between VRFs, AD cerebrospinal fluid (CSF) biomarkers, brain magnetic resonance imaging (MRI), and cognition in clinical context.
Methods:
We included patients from two memory clinics in University Hospital Aachen (Germany) and Maastricht University Medical Centre (The Netherlands). Subjects were older than 45 years and had available data on demographics, VRFs, CSF AD biomarkers, and MRI. We categorized individuals in normal AD biomarkers, non-AD change, and AD-continuum groups based on amyloid (A), tau (T), and neurodegeneration (N) status in CSF and MRI. Regression models were corrected for age, sex, and site.
Results:
We included 838 participants (mean age 68.7, 53.2% male, mean MMSE 24.9). The most common VRFs were smoking (60.9%), hypertension (54.6%), and dyslipidemia (37.8%). Alcohol abuse and smoking were most frequent in the non-AD-change group, and coronary heart disease and carotid artery stenosis in the AD continuum group. Higher rates of depression were found in the normal AD biomarkers group. Parietal atrophy and cortical microbleeds were specific for the AD continuum group. Carotid artery stenosis was associated with pathological Aβ42 and T-tau values, and diabetes and alcohol abuse were associated with worse medial temporal atrophy and atrial fibrillation, with worse cognition.
Conclusion:
VRFs are common in memory clinic patients, showing differences across the AT(N) biomarker groups. This is important for prevention and individualized treatment of dementia.
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