title: Late-onset dementia: structural brain damage and total cerebral blood flow.
abstract: OBJECTIVE
  To prospectively compare indicators of structural brain damage and total cerebral blood flow in patients with late-onset dementia, subjects of the same age with optimal cognitive function, and young subjects.
  
  
  METHODS
  The institutional ethics committee approved the studies, and all participants (or their guardians) gave informed consent. The test group included 17 patients older than 75 years (four men, 13 women; median age, 83 years) and with a diagnosis of dementia according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The control group included 16 subjects (four men, 12 women; median age, 87 years) with optimal cognitive function, who were selected from among 599 elderly subjects enrolled in a population-based follow-up study, and 15 young healthy subjects (seven men, eight women; median age, 29 years). Measurements of intracranial and total brain volumes, structural brain damage, and cerebral blood flow were obtained with magnetic resonance imaging. Mean values were compared with the t test; medians, with the Mann-Whitney U test.
  
  
  RESULTS
  Values for total brain volume were significantly smaller in elderly subjects (P < .001) but did not differ significantly between patients with dementia and subjects of the same age with optimal cognitive function (P = .69). Among the elderly, significantly higher scores for number and extent of white matter areas of signal hyperintensity (P = .028) and lower magnetization transfer ratios (P = .016) indicated greater structural brain damage in those with dementia. Cerebral blood flow was 246 mL/min lower (P < .001) in elderly subjects than in young subjects. In patients with dementia, cerebral blood flow was 108 mL/min lower than that in subjects of the same age with optimal cognitive function (551 vs 443 mL/min, P < .001).
  
  
  CONCLUSIONS
  The combined observations of more structural brain damage and lower cerebral blood flow in demented elderly individuals than in subjects of the same age with optimal cognitive function support the hypothesis that vascular factors contribute to dementia in old age.
authors: Department of Radiology, General Internal Medicine and Neurology, Leiden University Medical Center, Albinusdreef, C2-S, 2333 ZA Leiden, the Netherlands. A.Spilt@LUMC.nl
authors: Aart
authors: A
authors: Spilt
authors: Annelies W E
authors: AW
authors: Weverling-Rijnsburger
authors: Huub A M
authors: HA
authors: Middelkoop
authors: Wiesje M
authors: WM
authors: van Der Flier
authors: Jacobijn
authors: J
authors: Gussekloo
authors: Anton J M
authors: AJ
authors: de Craen
authors: Eduard L E M
authors: EL
authors: Bollen
authors: Gerard J
authors: GJ
authors: Blauw
authors: Mark A
authors: MA
authors: van Buchem
authors: Rudi G J
authors: RG
authors: Westendorp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003704:Dementia / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D018709:Statistics, Nonparametric