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


METHODS
Cross sectional case-control study.


METHODS
Secondary care old age psychiatry services, Manchester.


METHODS
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.


METHODS
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).


CONCLUSIONS
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.
Purandare
Nitin
N
Department of Psychiatry, University of Manchester, Manchester.
Burns
Alistair
A
Daly
Kevin J
KJ
Hardicre
Jayne
J
Morris
Julie
J
Macfarlane
Gary
G
McCollum
Charles
C
D000368:Aged; D000544:Alzheimer Disease / Q000209:etiology*; D016893:Carotid Stenosis / Q000150:complications; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D015140:Dementia, Vascular / Q000209:etiology*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications; D020766:Intracranial Embolism / Q000150:complications*; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D020768:Middle Cerebral Artery; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000150:complications