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(Stroke. 1999;30:2291-2295.)
© 1999 American Heart Association, Inc.

Original Contributions

Diagnostic Impact of Cerebral Transit Time in the Identification of Microangiopathy in Dementia

A Transcranial Ultrasound Study

Imke Puls, MD; Kurt Hauck, MD; Klaus Demuth, MD; Anja Horowski, MD; Mira Schließer; Petra Dörfler, MD; Peter Scheel, MD; Klaus V. Toyka, MD; Karlheinz Reiners, MD; Martin Schöning, MD Georg Becker, MD

From the Department of Neurology, Bayerische Julius-Maximilians-Universität, Würzburg (I.P., K.H., K.D., A.H., M.S., P.D., K.V.T., K.R., G.B.), and the Department of Pediatrics, Eberhard-Karls-Universität (P.S., M.S.), Tübingen, Germany.

Correspondence to PD Dr G. Becker, Neurologische Universitätsklinik, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany.

Background and Purpose—The diagnosis and quantification of microangiopathy in dementia is difficult. The assessment of small-vessel disease requires expensive and sophisticated nuclear medicine techniques. This study was performed to identify microangiopathy related to the integrity of cerebral microcirculation by sonographic measurements (arteriovenous cerebral transit time [cTT]).

Methods—We performed transcranial color-coded duplex sonography in 40 patients with vascular dementia, 20 patients with Alzheimer's disease or Lewy body disease, and 25 age-matched controls. The clinical diagnosis was established by history of dementia and neuroimaging findings. Cognitive impairment was assessed by the Mini-Mental State Examination and Alzheimer's Disease Assessment Scale. cTT is defined as the time required by an ultrasound contrast agent to pass from a cerebral artery to a vein. This was measured by recording the power-Doppler intensity curves in the P2 segment of the posterior cerebral artery and the vein of Galen. Previous studies have shown a prolongation of cTT in patients with cerebral microangiopathy.

Results—cTT was substantially prolonged in patients with vascular dementia (5.8 seconds; 25th percentile 4.5; 75th percentile 7.5; U test, P<0.001) compared with controls (3.1 seconds; 2.3; 3.4) but not in patients with degenerative dementia (3.7 seconds; 3.7; 4.2). In patients with vascular dementia, cTT was significantly correlated with cognitive impairment.

Conclusions—cTT may be useful tool to disclose small-vessel disease in demented patients. Examination is noninvasive and quickly performed. It may be also useful in follow-up examinations in patients undergoing therapy.

Key Words: Alzheimer's disease • cerebrovascular circulation • ultrasonography, Doppler, transcranial • ultrasonography, Doppler, duplex • vascular dementia

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