Decreased vasomotor reactivity in Alzheimer's disease.
BACKGROUND
Reduced cerebral blood flow and microvascular abnormalities have been suggested as the vascular pathogenesis of Alzheimer's disease (AD). Transcranial Doppler sonography (TCD) can be used as a noninvasive method for measuring cerebral vasomotor reactivity (VMR) which represent the capability of arterioles to dilate and constrict in order to maintain cerebral blood flow.


OBJECTIVE
The objective of this study was to determine whether VMR is decreased in AD patients.


METHODS
Seventeen consecutive patients who met NINDS-ADRDA criteria for AD, and 17 age- and sex-matched controls were included in this study. MRI and MRA were performed for the grading of white-matter lesions. Patients with cerebral infarct or stenosis of the middle cerebral artery (MCA) were excluded. The fixed TCD probe was used to monitor the mean flow velocity (MFV) in the MCA. A 6-L rebreathing bag was applied to patients for at least 5 minutes to elevate the CO(2) concentration, which was continuously monitored with a capnometer. VMR was calculated as the percentage change in the MFV.


RESULTS
Baseline characteristics - including cerebrovascular risk factors, grades of white-matter lesions, baseline MFV, and pulsatility index - did not differ between the two groups. Mini-Mental State Examination score was significantly low in AD group (20.5 vs. 27.5, p<0.05). VMR was significantly reduced in AD group both in the right-side (24.5% vs. 36.6%, p<0.05) and left-side (20.7% vs. 34.1%, p<0.05) MCAs.


CONCLUSIONS
Our finding that VMR is reduced in AD may be suggestive of underlying microangiopathic mechanism in AD patients. Future studies should check the validity of these experimental and hypothesis-generating pilot results.
Lee
Soon-Tae
ST
Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea.
Jung
Keun-Hwa
KH
Lee
Yong-Seok
YS