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

N. Purandare, A. Burns, K. J. Daly, J. Hardicre, J. Morris, Gary John MacFarlane, C. McCollum

Research output: Contribution to journalEditorial

96 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1119-1124
Number of pages5
JournalBritish Medical Journal
Volume332
DOIs
Publication statusPublished - Jul 2006

Keywords

  • PATENT FORAMEN OVALE
  • TRANSCRANIAL DOPPLER
  • MICROEMBOLIC SIGNALS
  • STROKE PATIENTS
  • ULTRASOUND
  • PREVALENCE
  • ROTTERDAM
  • STENOSIS
  • CRITERIA
  • BYPASS

Cite this

Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: case-control study. / Purandare, N.; Burns, A.; Daly, K. J.; Hardicre, J.; Morris, J.; MacFarlane, Gary John; McCollum, C.

In: British Medical Journal, Vol. 332, 07.2006, p. 1119-1124.

Research output: Contribution to journalEditorial

Purandare, N. ; Burns, A. ; Daly, K. J. ; Hardicre, J. ; Morris, J. ; MacFarlane, Gary John ; McCollum, C. / Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: case-control study. In: British Medical Journal. 2006 ; Vol. 332. pp. 1119-1124.
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title = "Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: case-control study",
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.",
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author = "N. Purandare and A. Burns and Daly, {K. J.} and J. Hardicre and J. Morris and MacFarlane, {Gary John} and C. McCollum",
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T1 - Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: case-control study

AU - Purandare, N.

AU - Burns, A.

AU - Daly, K. J.

AU - Hardicre, J.

AU - Morris, J.

AU - MacFarlane, Gary John

AU - McCollum, C.

PY - 2006/7

Y1 - 2006/7

N2 - 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.

AB - 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.

KW - PATENT FORAMEN OVALE

KW - TRANSCRANIAL DOPPLER

KW - MICROEMBOLIC SIGNALS

KW - STROKE PATIENTS

KW - ULTRASOUND

KW - PREVALENCE

KW - ROTTERDAM

KW - STENOSIS

KW - CRITERIA

KW - BYPASS

U2 - 10.1136/bmj.38814.696493.AE

DO - 10.1136/bmj.38814.696493.AE

M3 - Editorial

VL - 332

SP - 1119

EP - 1124

JO - BMJ

JF - BMJ

SN - 0959-8146

ER -