Background
Spontaneous cerebral emboli (SCE) are frequent in Alzheimer’s disease (AD) and vascular
dementia (VaD). We investigated the effect of SCE on the rates of cognitive and functional
decline in AD and VaD.
Methods
One hundred thirty-two patients with dementia (74 AD, National Institute of Neurological
and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association
[NINCDS/ADRDA] criteria; 58 VaD, National Institute of Neurological Disorders and
Stroke-Association Internationale pour la Recherche et l’Enseignement en Neurosciences
[NINDS/AIREN] criteria) underwent 1-hour transcranial Doppler for detection of SCE
(mean [SD] age 75.5 (7.4) years; 46% female). Neuropsychological tests (Mini-Mental
State Examination [MMSE], Alzheimer’s Disease Assessment Scale-Cognitive subscale
[ADAS-Cog], and Neuropsychiatric Inventory [NPI]) and assessment of activities of
daily living (Interview for Deterioration in Daily Living Activities in Dementia [IDDD])
were performed initially and 6 months later. SCE positive (SCE+ve, n = 47) and SCE
negative (SCE-ve, n = 85) patients were compared using repeated measures analyses
of variance (ANOVAs) adjusted for age, gender, and cardiovascular risk factors.
Results
SCE+ve patients with dementia, both AD and VaD, suffered a more rapid decline in cognitive
functioning over 6 months (ADAS-cog, mean increase 7.1 for SCE+ve compared with 3.3
for SCE-ve, p = .006) and activities of daily living (IDDD, mean increase 24.4 for
SCE+ve compared with 10.8 for SCE-ve, p = .014).
Conclusions
Asymptomatic SCE are associated with an accelerated cognitive and functional decline
in dementia. SCE may be a potentially treatable cause of disease progression in dementia.
Key Words
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Article info
Publication history
Published online: May 29, 2007
Accepted:
December 17,
2006
Received in revised form:
December 15,
2006
Received:
November 3,
2006
Identification
Copyright
© 2007 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
