BMJ  2006;332:1119-1124 (13 May), doi:10.1136/bmj.38814.696493.AE (published 28 April 2006)

Research

Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: case-control study

¹ Department of Psychiatry, University of Manchester, Manchester, ² Academic Surgery Unit, University of Manchester, ³ South Manchester University Hospitals NHS Trust, Manchester, ⁴ School of Epidemiology and Health Sciences, University of Manchester, Manchester M13 9PT

Abstract

Objective To compare the occurrence of spontaneous cerebral emboli and venous to arterial circulation shunts in patients with Alzheimer's disease or vascular dementia and controls without dementia.

Design Cross sectional case-control study.

Setting Secondary care old age psychiatry services, Manchester.

Participants 170 patients with dementia (85 with Alzheimer's disease, 85 with vascular dementia) and 150 age and sex matched controls. Patients on anticoagulant treatment, patients with severe dementia, and controls with marked cognitive impairment were excluded.

Main outcome measures Frequencies of detection of spontaneous cerebral emboli during one hour monitoring of the middle cerebral arteries with transcranial Doppler and venous to arterial circulation shunts by a transcranial Doppler technique using intravenous microbubbles as an ultrasound contrast.

Results Spontaneous cerebral emboli were detected in 32 (40%) of patients with Alzheimer's disease and 31 (37%) of those with vascular dementia compared with just 12 each (15% and 14%) of their controls, giving significant odds ratios adjusted for vascular risk factors of 2.70 (95% confidence interval 1.18 to 6.21) for Alzheimer's disease and 5.36 (1.24 to 23.18) for vascular dementia. These spontaneous cerebral emboli were not caused by carotid disease, which was equally frequent in dementia patients and their controls. A venous to arterial circulation shunt indicative of patent foramen ovale was found in 27 (32%) Alzheimer's disease patients and 25 (29%) vascular dementia patients compared with 19 (22%) and 17 (20%) controls, giving non-significant odds ratios of 1.57 (0.80 to 3.07) and 1.67 (0.81 to 3.41).

Conclusion Spontaneous cerebral emboli were significantly associated with both Alzheimer's disease and vascular dementia. They may represent a potentially preventable or treatable cause of dementia.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Cerebral emboli are linked with Alzheimer's disease and vascular dementia
BMJ 2006 332: 0. [Full Text]

Cerebral embolism and Alzheimer's disease

Miia Kivipelto and Alina Solomon
BMJ 2006 332: 1104-1105. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Purandare, N. (2009). Preventing dementia: role of vascular risk factors and cerebral emboli. Br Med Bull 91: 49-59 [Abstract] [Full text]  
• Skjelland, M., Krohg-Sorensen, K., Tennoe, B., Bakke, S. J., Brucher, R., Russell, D. (2009). Cerebral Microemboli and Brain Injury During Carotid Artery Endarterectomy and Stenting. Stroke 40: 230-234 [Abstract] [Full text]  
• Rapp, J. H., Pan, X. M., Neumann, M., Hong, M., Hollenbeck, K., Liu, J. (2008). Microemboli Composed of Cholesterol Crystals Disrupt the Blood-Brain Barrier and Reduce Cognition. Stroke 39: 2354-2361 [Abstract] [Full text]  
• Purandare, N, Oude Voshaar, R C, McCollum, C, Jackson, A, Burns, A (2008). Paradoxical embolisation and cerebral white matter lesions in dementia. Br. J. Radiol. 81: 30-34 [Abstract] [Full text]  
• MILLS, S, CAIN, J, PURANDARE, N, JACKSON, A (2007). Biomarkers of cerebrovascular disease in dementia. Br. J. Radiol. 80: S128-S145 [Abstract] [Full text]  
• Vandenbroucke, J. P., Elm, E. v., Altman, D. G., Gotzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., for the STROBE initiative, (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. ANN INTERN MED 147: W-163-W-194 [Abstract] [Full text]  
• Kovari, E., Gold, G., Herrmann, F. R., Canuto, A., Hof, P. R., Bouras, C., Giannakopoulos, P. (2007). Cortical microinfarcts and demyelination affect cognition in cases at high risk for dementia. Neurology 68: 927-931 [Abstract] [Full text]  
• Purandare, N., Voshaar, R. C. O., Hardicre, J., Byrne, J., McCollum, C., Burns, A. (2006). Cerebral emboli and depressive symptoms in dementia. Br. J. Psychiatry 189: 260-263 [Abstract] [Full text]  
• (2006). Cerebral Emboli: A Cause of Dementia?. JWatch General 2006: 2-2 [Full text]  
• Kivipelto, M., Solomon, A. (2006). Cerebral embolism and Alzheimer's disease.. BMJ 332: 1104-1105 [Full text]  

Rapid Responses:

Read all Rapid Responses

Vascular dementia and Alzheimer’s disease: Do they have similar aetiologies?

Jonathan Golledge
bmj.com, 30 Apr 2006 [Full text]

Diagnosis of Alzeimers Disease (AD) and Vascular Dementia(VD) in clinical practice

Dipankar Choudhury
bmj.com, 5 May 2006 [Full text]

Alzheimer's and Vascular dementias

Memo (Dr G. S.) Spathis
bmj.com, 16 May 2006 [Full text]

Query about medication

A.M. Haddow
bmj.com, 18 May 2006 [Full text]

PFO, cerebral emboli and Alzheimer’s disease: investigative artifact or biological truth?

Vinod K Gupta
bmj.com, 30 May 2006 [Full text]

Reply from the authors

Charles N McCollum, et al.
bmj.com, 9 Jun 2006 [Full text]

PFO, Alzheimer’s disease, migraine, and indomethacin: how to approach assumptions, clinical data, and pathophysiological uncertainties

Vinod K Gupta
bmj.com, 13 Jun 2006 [Full text]

"Alzheimer's disease" may not be a disease at all.

knight steel, et al.
bmj.com, 16 Jun 2006 [Full text]

Online poll

Find out more here>> and here>>