Lipids' peroxidation markers in Alzheimer's disease and vascular dementia

Aim: Although a large body of evidence supports a role of oxidative stress in the etiopathogenesis of dementia, there is still a substantial lack of data regarding the biomarkers of oxidative stress characteristic of Alzheimer's disease (AD) as opposed to different types of dementia. In this study, the level of various oxidative stress parameters were measured in AD, vascular dementia (VaD), and age‐ and sex‐matched control patients. The AD and VaD patients all had similar levels of cognitive impairment as measured by the Mini‐Mental State Examination. Methods: Thirty AD, 19 VaD and 29 controls patients were recruited to the study. Plasma levels of malondialdehyde (MDA), total sulfhydryl (T‐SH), calcium (Ca⁺⁺) and magnesium (Mg⁺⁺) were measured. Results: In both AD and VaD groups, the levels of oxidative stress parameters were higher compared with controls. Further, the VaD patients expressed significantly higher levels of plasma parameters of oxidative stress than AD. The difference was noted in MDA, the marker of lipid peroxidation, whereas in VaD the level of MDA was more than 2.8‐fold higher than that registered in AD patients. Conclusion: Vascular dementia in patients is characteristic of increased levels of oxidative stress, especially lipid peroxidation markers. This finding is relevant to determining the pathophysiology of dementia, particularly in the light of the recently suggested importance of the vascular component in dementia development, in addition to aiding in the diagnosis of VaD following clinical presentation. The study will be continued to compare the character and level of decline in both groups.     

Association between dementia and midlife risk factors: the Radiation Effects Research Foundation Adult Health Study

OBJECTIVES: To investigate the association between midlife risk factors and the development of vascular dementia (VaD) or Alzheimer's disease (AD) 25 to 30 years later. DESIGN: A prevalence study within a longitudinal cohort study. SETTING: Subjects in the Adult Health Study (a prospective cohort study begun in 1958) have been followed through biennial medical examinations in Hiroshima, Japan. PARTICIPANTS: One thousand seven hundred seventy-four subjects in Hiroshima, Japan born before September 1932 (1,660 with no dementia, 114 with dementia (51 with AD, and 38 with VaD) diagnosed from 1992 to 1997 according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). MEASUREMENTS: The subjects were examined for effect on dementia of sex, age, education, atomic bomb radiation dose, and midlife factors associated with risk (smoking, alcohol intake, physical activity, dietary habits, systolic blood pressure (SBP), body mass index, and history of diabetes mellitus) that had been evaluated in 1965-1970. RESULTS: VaD prevalence increased significantly with age, higher SBP, and lower milk intake. The odds ratios of VaD for age (in 5-year increments), SBP (10 mmHg increments), and milk intake (almost daily/less than four times a week) were 1.29, 1.33, and 0.35, respectively. The risk factors for VaD were compatible with the risk factors for stroke in this study population. AD prevalence increased significantly with age and lower education. Other midlife factors and radiation dose did not show any significant association with VaD or AD. CONCLUSION: Increased SBP and low milk intake in midlife were associated with VaD detected 25 to 30 years later. Early behavioral control of the risk factors for vascular disease might reduce the risk of dementia.     

Relationship between serum insulin-like growth factor-1 levels and Alzheimer's disease and vascular dementia

OBJECTIVES: To determine whether decreased serum insulin-like growth factor-1 (IGF-1) levels could be a risk factor for dementia in older people. DESIGN: Case control study. SETTING: Showa University Karasuyama Hospital, Tokyo, Japan. PARTICIPANTS: A total of 436 Japanese elderly subjects: 106 patients with Alzheimer's disease (AD), 103 patients with vascular dementia (VaD), and 227 age-matched controls without dementia. MEASUREMENTS: Serum concentrations of IGF-1 and atherogenic lipoproteins, carotid artery intima-media thickness (IMT), and plaques were determined. RESULTS: Mini-Mental State Examination (MMSE) scores were positively correlated with serum IGF-1 concentrations as well as mean blood pressure or body mass index and were negatively correlated with age, serum low-density lipoprotein cholesterol and lipoprotein(a) concentrations, and carotid IMT. Serum IGF-1 concentrations had a significant inverse correlation with carotid IMT. Analysis across the IGF-1 quartiles revealed a threshold effect of low IGF-1 on MMSE score in subjects with the IGF-1 levels of 140 ng/mL or less (50% percentile) versus those with IGF-1 levels greater than 140 ng/mL. Multiple logistic regression concerning AD and VaD retained serum IGF-1 concentrations of 140 ng/mL or less and carotid IMT of 0.9 mm or more. Patients with AD and VaD had significantly lower IGF-1 concentrations and greater mean IMT than nondemented controls. CONCLUSION: These results suggest that decreased serum IGF-1 level and the progression of carotid atherosclerosis could play a role as independent risk factors for dementia.     

Different changes of bone mineral density and nutritional status after hospitalization between vascular dementia and Alzheimer's disease in elderly female patients

Background:   Bone fractures strongly influence morbidity and mortality in elderly patients with dementia. The goal of this study was to examine whether difference in the type of dementia affects changes of bone mineral density (BMD) during hospitalization with rehabilitation programs.
Methods:   Ninety-four Japanese elderly female patients were enrolled. BMD, Mini-Mental State Examination (MMSE) scores, and levels of serum albumin, calcium-related factors and urinary calcium excretion were measured.
Results:   Multivariable analyses indicated that serum albumin levels and MMSE scores were positively correlated with changes in BMD after 2 years hospitalization. Significant reduction of BMD levels after hospitalization were observed in patients with severe dementia (MMSE scores, <10) or with severe malnutrition (serum albumin, <2.0). We next classified our subjects into three groups according to the 4th edn of the Diagnostic and Statistical Manual criteria: non-dementia (ND), Alzheimer's disease (AD) and vascular dementia (VaD). Although there were no significant differences in age and physical activities among the groups; the levels of BMD were maintained in AD as well as ND but not in VaD. Notably, calcium excretion levels were significantly decreased after hospitalization in AD as well as ND but not in VaD. Serum 25(OH)D levels were also restored in AD but not in VaD. In addition, the nutritional status significantly improved in AD but not in VaD.
Conclusion:   The levels of BMD were maintained and the nutritional status was improved in AD but not in VaD for 2 years hospitalization with rehabilitation programs. These results suggest that different programs including nutritional support may be necessary for maintaining BMD levels in VaD as compared with AD during hospitalization.     

Cerebrospinal fluid amyloid beta42/phosphorylated tau ratio discriminates between Alzheimer's disease and vascular dementia

BACKGROUND: The differentiation of Alzheimer's disease (AD) from vascular dementia (VaD) is hampered by clinical diagnostic criteria with disappointing sensitivity and specificity. The objective of this study was to investigate whether cerebrospinal fluid (CSF) levels of total tau protein (t-tau), amyloid beta42 protein (Abeta42), and tau phosphorylated at threonine 181 (p-tau181) are useful biomarkers to distinguish AD patients from VaD patients. METHODS: We measured CSF levels of p-tau181, Abeta42, and t-tau in 86 patients with a clinical diagnosis of AD or VaD and in 30 control participants. RESULTS: Optimal differentiation between AD and VaD was achieved by using the ratio of the CSF levels of Abeta42 and p-tau181 (Q Abeta42/p-tau) with sensitivity, specificity, positive and negative predictive values all > or = 85%. CONCLUSIONS: Our results support further efforts to prospectively validate the use of Q Abeta42/p-tau as a biomarker to discriminate between AD and VaD.     

阿尔茨海默病和血管性痴呆患者血管紧张素转换酶和载脂蛋白E基因多态性分析

目的　探讨阿尔茨海默病 (AD)及血管性痴呆 (VaD)与血管紧张素转换酶 (ACE)和载脂蛋白E(apoE)基因多态性的关系。方法　应用聚合酶链反应和限制性片段长度多态性方法 ,检测了 2 6例晚发AD患者、5 4例VaD患者和6 8例正常老年人的ACE和apoE基因多态性。结果　AD组中apoE等位基因频率分别为ε2 0 .0 77、ε30 .6 15及ε40 .30 8,VaD组apoE等位基因频率分别为ε2 0 .0 5 6、ε30 .6 85及ε4 0 .2 5 9,AD组和VaD组apoEε4等位基因频率显著高于对照组。ACE基因AD组和VaD组DD型频率高于对照组 ,D等位基因亦高于对照组。结论　ACEDD型、apoEε4可能是AD及VaD发病的危险因素     

Body mass index (BMI) at an early age and the risk of dementia

BMI change and BMI at an early age have not been investigated as risks for dementia. This case-control study included 286 dementia patients and 268 controls from two medical centers between 2007 and 2009. BMI information was collected from medical records and questionnaires. Men and women with low BMIs at the time of the study, in their 20s, and in their 40s had significantly increased risks of Alzheimer's disease (AD) (odds ratio = OR = 2.62–3.97) and increased vascular dementia (VaD) risk (20s and 40s: OR = 6.23–11.11) compared with those with normal BMIs. High BMI in the 20s and 40s was associated with increased VaD risk (OR = 15.29 and 10.32) among women. For BMI changes from the 20s or 40s, the second and third tertiles were significantly associated with decreased AD risk among women (OR = 0.15–0.35) compared to the first tertile. The third tertile of BMI change from the 20s or 40s was associated with decreased VaD risk among women (OR = 0.06 and 0.14). Low BMIs in the 20s and 40s were stronger predictors of AD and VaD. There was a U-shaped association between BMI at different ages and dementia among participants with VaD.     

脑脊液磷酸化tau蛋白的检测对阿尔茨海默病的诊断价值

目的通过对阿尔茨海默病(AD)患者脑脊液磷酸化tau蛋白检测的研究,探讨其对AD的诊断价值。方法采用ELISA法检测11例AD患者(AD组)、13例血管性痴呆患者(血管性痴呆组)及29例非神经系统疾病患者(正常对照组)的脑脊液磷酸化tau蛋白。结果与血管性痴呆组和正常对照组比较,AD组患者脑脊液中磷酸化tau蛋白含量明显增高(P<0.05)。血管性痴呆组患者脑脊液中磷酸化tau蛋白水平与正常对照组比较无明显差异(P>0.05)。结论检测脑脊液磷酸化tau蛋白含量可作为AD诊断的辅助指标。     

Comparison of vascular stiffness in vascular dementia, Alzheimer dementia and cognitive impairment

Abstract Defining the vascular component(s) of the clinical diagnosis of vascular cognitive impairment (VCI) and vascular dementia (VaD) continues to be problematic. The goal of this study was to determine whether vascular stiffness, measured by pulse wave velocity (PWV), is altered in VaD, to study the utility of PWV in differentiating VaD from Alzheimer dementia (AD) and the relationship between PWV and cognitive function. A qualitative and quantitative structured analysis of the literature was conducted until September 2010, using a search strategy based on the key words: dementia, vascular dementia, dementia of vascular origin, cognitive function and arterial stiffness or pulse wave velocity. Seventeen studies assessed large vessel vascular stiff by PWV and related it to cognitive function or dementia. Six of these studies compared PWV in 154 persons with VaD, 207 with AD and 197 controls without dementia. Mean PWV was significantly (p < 0.0001) higher in VaD compared with controls. Mean PWV was significantly (p = 0.002) higher in VaD compared with AD. Fourteen studies examined the relationship between PWV and cognitive function. The majority of studies (nine of 14) reported a significant correlation between PWV and cognitive function. Four of eight studies that evaluated the relation using univariate analysis reported a significant correlation of PWV with the Mini Mental State Exam (MMSE) or Hasegawa Dementia Scale, and the correlation with MMSE between studies showed a close agreement of correlation coefficients (0.206 to 0.27). In multivariate analysis, adjusted for a wide range of possible confounding factors, the majority or 80% (eight out of 10) studies comprising a population of 6,034 individuals found a significant inverse relationship between PWV and cognitive function. In summary, vascular stiffness is inversely related to cognitive function. Vascular stiffness is greater in VaD compared with AD, suggesting PWV may be useful in identifying VaD.     

Toll样受体4在阿尔茨海默病及血管性痴呆患者外周血单核细胞表达的初步研究

目的:检测Toll样受体4(TLR4)在阿尔茨海默病(AD)及血管性痴呆(VaD)患者外周血单核细胞的表达情况,探讨TLR4在老年期痴呆发病机制中的可能作用。方法:选择临床确诊的AD患者(n=26)、VaD患者(n=31)和正常对照组(n=29)共86例,采用流式细胞术检测3组外周血单核细胞膜上TLR4蛋白阳性表达率及平均荧光强度(MFI)并进行比较分析。结果:外周血单核细胞膜表达TLR4的阳性表达率和MFI AD组和VaD组较对照组明显增高(P0.05)。结论:TLR4作为免疫炎性机制信号通路的关键蛋白,在AD、VaD的发病中均表现为增高,提示炎性机制在AD和VaD的发病中均发挥了作用,TLR4可能不能作为鉴别诊断的潜在生物标志物。     

High prevalence of Chlamydia pneumoniae antibodies and increased high-sensitive C-reactive protein in patients with vascular dementia

OBJECTIVES: To determine the relationships between Chlamydia pneumoniae infection, carotid atherosclerosis, and dyslipidemia in patients with vascular dementia (VaD) and Alzheimer's disease (AD). DESIGN: Case control study. SETTING: Showa University Karasuyama Hospital, Tokyo, Japan. PARTICIPANTS: One hundred twenty-four elderly subjects: 31 with VaD, 61 with AD, and 32 age-matched controls without dementia. MEASUREMENTS: Presence of antibodies to C. pneumoniae (immunoglobulin G (IgG) and IgA), the serum concentrations of high-sensitive C-reactive protein (hs-CRP) and atherogenic lipoproteins, and the carotid artery intima-media thickness (IMT) and plaques were determined. RESULTS: Age; body mass index; systolic and diastolic blood pressures; and fasting plasma glucose, hemoglobin A(1c), high-density lipoprotein cholesterol, and apolipoprotein A-I, B, and E concentrations did not differ significantly between the three groups, but the mean IMT and frequency of atherosclerotic plaques in the carotid arteries, as well as the serum concentrations of low-density lipoprotein cholesterol (LDL-C), lipoprotein(a), and lipid peroxides were significantly greater in VaD patients than in AD patients or nondemented controls. Hs-CRP concentrations and prevalence of C. pneumoniae IgG and IgA antibodies also were significantly higher in VaD patients than in AD patients and nondemented controls. Multiple logistic regression analysis revealed that carotid IMT and plaques, LDL-C, lipid peroxides, hs-CRP, and IgG and IgA C. pneumoniae seropositivity were independent risk factors for VaD. CONCLUSION: These results suggest that carotid atherosclerosis, atherogenic lipoproteins, and C. pneumoniae infection (as documented by the IgG and IgA seropositivity together with increased hs-CRP) may be VaD risk factors.     

Seroprevalence ofHelicobacter pylori and association with atrophic gastritis in patients with Sjögren’s syndrome

To investigate the association betweenHelicobacter pylori (HP) infection and atrophic gastritis in Sjögren’s syndrome (SS), we conducted an age-matched case-control study examining serum HP-IgG antibodies and pepsinogen (PG) I and II levels using ELISA. The sera of 82 primary SS (1-SS), and 57 secondary SS (2-SS) were studied, as well as 198 controls having a diagnosis of connective tissue disease (CTD), except for SS which were obtained according to age. The titers of HP-IgG in 1-SS were significantly much higher than those in either 2-SS or control. The HP-IgG level revealed an exclusively positive correlation with the serum PG II level and a negative correlation with the PG I/II ratio. Serum PG II levels and PG I/II ratios were associated with the positivity of HP-IgG antibodies. The age-specific seroprevalence rates of HP infection in SS patients compared with controls showed a high positivity in patients less than 49 years old, but no difference among the higher age groups because of increasing positive rates with advancing age in the control. The matched odds ratio with HP infection in all SS (1-SS and 2-SS) and in 1-SS were 2.33 (95% CI: 1.43–3.81) and 2.75 (95% CI: 1.50–5.05), respectively. However, the positive PG I/II ratio did not show a statistically significant odds ratio for SS. We conclude that SS patients have a highly positive association with HP infection and that atrophic gastritis with SS may occur as a result of HP infection.     

Seroprevalence of Helicobacter pylori and association with atrophic gastritis in patients with Sjögren’s syndrome

Abstract

To investigate the association between Helicobacter pylori (HP) infection and atrophic gastritis in Sjögren’s syndrome (SS), we conducted an age-matched case-control study examining serum HP-IgG antibodies and pepsinogen (PG) I and II levels using ELISA. The sera of 82 primary SS (1-SS), and 57 secondary SS (2-SS) were studied, as well as 198 controls having a diagnosis of connective tissue disease (CTD), except for SS which were obtained according to age. The titers of HP-IgG in 1-SS were significantly much higher than those in either 2-SS or control. The HP-IgG level revealed an exclusively positive correlation with the serum PG II level and a negative correlation with the PG I/II ratio. Serum PG II levels and PG I/II ratios were associated with the positivity of HP-IgG antibodies. The age-specific seroprevalence rates of HP infection in SS patients compared with controls showed a high positivity in patients less than 49 years old, but no difference among the higher age groups because of increasing positive rates with advancing age in the control. The matched odds ratio with HP infection in all SS (1-SS and 2-SS) and in 1-SS were 2.33 (95% CI: 1.43–3.81) and 2.75 (95% CI: 1.50–5.05), respectively. However, the positive PG I/II ratio did not show a statistically significant odds ratio for SS. We conclude that SS patients have a highly positive association with HP infection and that atrophic gastritis with SS may occur as a result of HP infection.     

Small dense low-density lipoprotein and carotid atherosclerosis in relation to vascular dementia

Vascular dementia (VaD) and Alzheimer's disease (AD) are the most common causes of dementia in the elderly. The aim of this study was to investigate carotid atherosclerosis, serum lipid profiles, and atherogenic hormone levels in nondiabetic Japanese men with VaD or AD. Carotid artery intima-media thickness (IMT) and plaque, serum lipid and lipoprotein profiles, including low-density lipoprotein (LDL) particle size, as well as insulin-like growth factor-I (IGF-I, somatomedin C) and testosterone levels, were determined in 34 patients with AD, 37 patients with VaD, and 63 healthy male controls. Age, body mass index, systolic and diastolic blood pressure, and fasting plasma glucose, hemoglobin A(1c) (HbA(1c)), triglyceride, high-density lipoprotein (HDL)-cholesterol, and apolipoproteins (apo) A-I, B, and E levels did not differ significantly among the 3 groups. However, the mean value of carotid IMT, the frequency of atherosclerotic plaque deposition, the serum levels of LDL-cholesterol, lipoprotein(a), and lipid peroxides, and the incidence of small dense LDL (particle diameter 相似文献   

血清睾酮及雌二醇与老年男性痴呆类型和严重程度的关系

目的探讨血清总睾酮(TT)、雌二醇(E2)与老年男性痴呆类型和严重程度的关系。方法选择111例男性老年人,将认知功能正常的老年人28例作为正常组,轻度认知损害(MCI)患者15例作为MCI组,阿尔茨海默病(AD)患者50例作为AD组(其中轻、中、重度分别为17、18和15例),血管性痴呆(VaD)患者18例作为VaD组,检测TT和E2浓度。痴呆严重程度根据通用的临床痴呆评价量表评分。应用协方差分析、相关分析和χ~2检验方法分析TT、E2与AD和VaD及其严重程度的关系。结果 MCI组、正常组和轻度AD患者的TT和F2水平差异均无统计学意义。AD组患者TT和E2水平明显低于正常组(P<0.05)。随着认知损伤程度的加重,AD组患者TT呈下降趋势(Spearman's ρ_s=-0.4709,P<0.001),且TT低下患者的比例增多。VaD组、AD组、正常组3组间比较,TT和E2水平以及TT和E2低下患者的比例差异均无统计学意义。结论 TT下降与AD及其严重程度相关,血清E2下降与AD相关,但与其严重程度无关,二者与VaD均无明显相关性。     

Serum uric acid level and association with cognitive impairment and dementia: systematic review and meta-analysis

Serum uric acid (sUA) level may be associated with cognitive impairment/dementia. It is possible this relationship varies with dementia subtype, particularly between vascular dementias (VaD) and Alzheimer’s (AD) or Parkinson’s disease (PDD)-related dementia. We aimed to present a synthesis of all published data on sUA and relationship with dementia/cognition through systematic review and meta-analysis. We included studies that assessed the association between sUA and any measure of cognitive function or a clinical diagnosis of dementia. We pre-defined subgroup analyses for patients with AD, VaD, PDD, mild cognitive impairment (MCI), and mixed or undifferentiated. We assessed risk of bias/generalizability, and where data allowed, we performed meta-analysis to describe pooled measures of association across studies. From 4811 titles, 46 papers (n?=?16,688 participants) met our selection criteria. Compared to controls, sUA was lower in dementia (SDM ?0.33 (95%CI)). There were differences in association by dementia type with apparent association for AD (SDM ?0.33 (95%CI)) and PDD (SDM ?0.67 (95%CI)) but not in cases of mixed dementia (SDM 0.19 (95%CI)) or VaD (SDM ?0.05 (95%CI)). There was no correlation between scores on Mini-Mental State Examination and sUA level (summary r 0.08, p?=?0.27), except in patients with PDD (r 0.16, p?=?0.003). Our conclusions are limited by clinical heterogeneity and risk of bias in studies. Accepting this caveat, the relationship between sUA and dementia/cognitive impairment is not consistent across all dementia groups and in particular may differ in patients with VaD compared to other dementia subtypes.     

Mild cognitive impairment subtypes and vascular dementia in community-dwelling elderly people: a 3-year follow-up study

OBJECTIVES: To investigate whether mild cognitive impairment (MCI) with multiple impaired cognitive domains (mcd-MCI) is a prodromal manifestation of vascular dementia (VaD). DESIGN: Prospective cohort study. SETTING: Geriatric unit of the Ospedale Maggiore Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy. PARTICIPANTS: Four hundred community-dwelling subjects aged 65 and older who came freely to the geriatric unit as part of a comprehensive geriatric assessment program were evaluated for memory impairment or other cognitive disorders. Subjects with MCI were kept under observation for 3 years. MEASUREMENTS: Subjects with MCI were studied by applying a standardized clinical evaluation and a conducting a computed tomography brain scan. Cognitive performance was assessed using the Mini-Mental State Examination, the Clock Drawing Test, and a comprehensive battery of neuropsychological tests. Cardiovascular comorbidity was assessed on the basis of medical history and using electrocardiography, echocardiography, and carotid color Doppler ultrasound. RESULTS: MCI was found in 65 of the 400 community-dwelling subjects; 31 were classified with amnestic MCI (a-MCI) and 34 with mcd-MCI. A dysexecutive syndrome characterized people with mcd-MCI, who had significantly more vascular comorbidity and signs of vascular disease on brain imaging as well as a higher prevalence of extra pyramidal features, mood disorders, and behavioral symptoms than people with a-MCI. Twenty of the 65 subjects with MCI (31%) progressed to dementia within 3 years of follow-up: 11 subjects with Alzheimer's disease (AD) and nine with VaD. All patients who evolved to AD had been classified with a-MCI at baseline, whereas all patients who evolved to subcortical VaD had been classified with mcd-MCI at baseline. CONCLUSION: All subjects who converted to subcortical VaD had been classified with mcd-MCI, suggesting that mcd-MCI might be an early stage of subcortical VaD.     

The relationship between Helicobacter pylori IgG titre and coronary atherosclerosis

OBJECTIVES: The role of Helicobacter pylori (HP) in the progression of atherosclerosis is controversial. We investigated the relation between HP IgG antibody titres and severity and intensity of coronary atherosclerosis and also clinical presentation of coronary artery disease (CAD). METHODS: The patient group consisted of 353 patients with angiographically proven CAD, which contains 3 different subgroups: 163 patients with myocardial infarction (MI), 106 patients with unstable angina (USAP) and 84 patients with stable angina (SAP). Control group included 163 subjects with angiographically proven normal coronary arteries. Helicobacter pylori IgG antibody titres were measured by an enzyme immunoassay method in all patients. Gensini and Extent scores were used to evaluate the angiographic severity and extent of atherosclerosis. C-reactive protein levels were measured by Behring nephelometry system kits. RESULTS: Seropositivity rates for HP were similar between groups (82.7% in the patient group and 86.6% in the control group (P > 0.05)). Also HP-IgG levels were similar among the MI, USAP and SAP groups. No significant correlation was observed between CRP levels and HP-LgG level titres. There was no significant correlation between HP-IgG level (r = 0.086, P = 0.2) and Gensini score but a significant poor correlation was observed between HP-IgG level and Extent score (r = + 0.156, P = 0.03). CONCLUSIONS: Helicobacter pylori IgG titres do not play an important role in the presentation of CAD and do not increase systemic inflammatory response. However, Helicobacter pylori IgG antibody titres may be correlated with the extent of CAD.     

Clock drawing testing and diffusion tensor imaging among vascular dementia versus Alzheimer's disease

PurposeTo assess the clock drawing testing (CDT) and diffusion tensor magnetic resonance imaging (DT-MRI) differences between probable Alzheimer's dementia (AD) and vascular dementia (VaD) and the CDT correlation with the DT-MRI.Subjects and methodsElderly patients presenting at the Geriatric outpatient clinic-Ain Shams University Hospitals, Egypt over a period of 6 months were recruited for the study. Tools of assessment including activities of daily living, geriatric depression scale-15 items, Mini-mental status examination, and Clock drawing test using Shulman et al. scoring system were applied to all participants. Diagnosis of dementia and its subtypes was confirmed using DSM-IV criteria. From the assessed subjects, thirty participants; ten cases of probable AD, ten cases of VaD and ten controls, were randomly chosen for assessment using DT-MRI, where apparent diffusion coefficient (ADC), and fractional anisotropy (FA), were evaluated in 15 regions of interest in the cerebral hemispheres.ResultsVaD cases showed significantly worse performance in CDT than AD cases with more prevalence of spacing errors among them. CDT had significant correlation with age, MMSE and ADL. Dementia was associated with increased ADC and decreased FA in DT-MRI. VaD had lower FA than AD. CDT was significantly correlated with white matter integrity of several areas on DT-MRI.ConclusionCDT differs among VaD and AD with a range of radiological correlations. DT-MRI is a sensitive and discriminative technique for evaluation of patients with dementia including probable AD and VaD. Larger studies are needed for establishing reference ranges.     

高血浆高半胱氨酸和脂蛋白相关磷脂酶A2水平与痴呆的相关性

目的 探讨血浆高半胱氨酸(homocysteine, Hcy)和脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2, Lp-PLA2)水平与痴呆的相关性.方法 回顾性纳入住院的痴呆患者,根据Hachinski缺血量表分为血管性痴呆(vascular dementia, VaD)组、混合性痴呆(mixed dementia, MD)组和阿尔茨海默病(Alzheimer''s disease, AD)组,同时根据简易精神状态检查量表将痴呆严重程度分为轻度、中度和重度.另选同时期住院的非痴呆患者作为对照组.比较各组人口统计学、血管危险因素以及血浆Hcy和Lp-PLA2水平.应用logistic回归分析确定血浆Hcy和Lp-PLA2水平与痴呆风险和严重程度的独立相关性.结果 共纳入125例痴呆患者,VaD组52例(41.6%),MD组21例(16.8%),AD组52例(41.6%);轻度组49例(39.2%),中度组51例(40.8%),重度组25例(20%).40例非痴呆患者被纳入作为对照组.VaD组、MD组和AD组血浆Hcy及Lp-PLA2水平均显著高于对照组(P均<0.001).多变量logistic回归分析显示,高龄[优势比(odds ratio, OR)1.12,95%可信区间(confidence interval, CI)1.03~1.21;P=0.010]、高血浆Hcy水平(OR 1.44,95% CI 1.21~1.71;P<0.001)、高Lp-PLA2水平(OR 1.01,95% CI 1.00~1.02;P=0.006)和既往卒中史(OR 4.29,95% CI 1.50~12.36;P=0.007)是痴呆的独立危险因素;高Hcy水平(OR 1.48,95% CI 1.21~1.82;P<0.001)、高Lp-PLA2水平(OR 1.01,95% CI 1.00~1.03;P=0.002)和既往卒中史(OR 152.78,95% CI 20.41~999.97;P<0.001)是VaD的独立危险因素;高龄(OR 1.10,95% CI 1.02~1.17;P=0.008)和高Hcy水平(OR 1.41,95% CI 1.25~1.58;P<0.001)是重度痴呆的独立危险因素.结论 血浆Hcy和Lp-PLA2水平升高与痴呆相关,降低血浆Hcy和Lp-PLA2水平可能对治疗和预防痴呆有益.