Escolar Documentos
Profissional Documentos
Cultura Documentos
Aging and dementia are associated with changes in cerebrovascular structure and function cognitive and functional declines
Recent autopsy studies have stressed the important role of vascular pathologies in the manifestation of late onset dementia
Alzheimers disease (AD) and vascular dementia (VaD) have generally reported reduced cerebral perfusion Chronic cerebral hypoperfusion could affect cellular health within the brain and the development of neurodegenerative pathologies
Cerebral amyloid angiopathy refers to the deposition of -amyloid in the media and adventitia of small and mid-sized arteries. Cerebral amyloid angiopathy has been recognized as one of the morphologic hallmarks of Alzheimer disease
The 3 most common mechanisms of vascular dementia are multiple cortical infarcts, a strategic single infarct, and small vessel disease.
Arterial stiffness, which reflects an alteration in arterial mechanics, can be a risk factor for vascular dementia
Transcranial Doppler (TCD) ultrasonography is a non-invasive, inexpensive and portable technique allowing continuous and bilateral recording of cerebral blood flow velocity through the major arteries
Midle cerebral artery (MCA), Anterior cerebral artery (ACA) Posterior cerebral artery (PCA) Bifurcatio ICA-MCA Distal ICA
INSONATION
TCD methods have much to provide the assessment of functional cerebrovascular contributions to cognitive impairment and may help in the differentiation of dementia from normal aging and between the subtypes such as AD and VaD.
REST
TCD metrics were employed to assess cerebral blood flow at rest including
mean flow velocity systolic velocity diastolic velocity pulsatility index emboli
(PSV-EDV)+EDV 3
Systolic upstroke or acceleration is defined as the initial slope of the peak velocity envelope during systole; corresponds to maximal contraction of left ventricle
PULSATILITY INDEX
PULSATILITY INDEX
Low MFV/high PI (2 or more artery) were documented in multiple vessels byTCD in patients with diffuse intracranial disease on contrast angiography (Sharma et al 2007) Dementia patients also demonstrated correlation between low velocity/high resistance flow pattern with degree of cumulative intracranial stenosis due to atheromatous disease (autopsy-based reports) (Roher AE et al 2004)
Transcranial Doppler ultrasound blood flow velocity and pulsatility index as systemic indicators for Alzheimers disease
Alex E et al 2011
Association of Cerebral Emboli With Accelerated Cognitive Deterioration in Alzheimers Disease and Vascular Dementia
Nitin P et al 2012
Conclusions :
Spontaneous cerebral emboli predict more rapid progression of dementia over 2 years in both Alzheimers disease and vascular dementia
VASOMOTOR REACTIVITY
TCD is an ideal functional test for detecting rapid changes in cerebral perfusion.
Functional tests are evaluating the reserve mechanism of the cerbral vasculature using various stimuli such as hypocapnia or hypercapnia, increased or reduced systemic arterial pressure, and hypoxia
The assessment of cerebral vasoreactivity can provide information about vessels to adapt in response to systemic modification or brain metabolic activity requiring an increase or decrease in cerebral blood flow
Dahal A et al 2002
Reduction of this property has been found in association with situations predisposing one toward cerebrovascular disease
Chimowitz A et al 1992
Vasomotor Reactivity
Breath holding
Hyperventilation
Normal vasomotor
Cerebrovascular Reactivity in Degenerative and Vascular Dementia: A Transcranial Doppler Study 60 AD,58 VaD, 62 NDC. AD-VaD subjects CO2 mixture inhalation followed by hyperventilation Lower FV and higher (PI) as compared with controls. Lower total VMR AD VaD groups as compared with controls. AD and VaD patients did not show significant differences (FV, PI values,cerebral vasoreactivity)
Vicenzini E et al,2007
VMR was significantly reduced in AD group both in the rightside (24.5% vs. 36.6%, p<0.05) and left-side (20.7% vs. 34.1%, p<0.05) MCAs