Published Online
on February 23, 2006

A more recent version of this article appeared on April 1, 2006

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Submitted on November 18, 2005
Revised on December 20, 2005
Accepted on December 23, 2005

Cerebrovascular Reactivity and Cognitive Decline in Patients With Alzheimer Disease

Mauro Silvestrini MD^*; Patrizio Pasqualetti PhD; Roberto Baruffaldi MD; Marco Bartolini MD; Yasmin Handouk MD; Maria Matteis PhD; Filomena Moffa PhD; Leandro Provinciali MD; and Fabrizio Vernieri MD

From the Neurological Clinic (M.S., R.B., M.B., Y.H., L.P.), Polytechnic University of Marche, Ancona, Italy; Department of Neuroscience (P.P., F.M.), AfaR-Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy; IRCCS Fondazione Santa Lucia (M.M.), Roma, Italy; and Neurological Clinic (F.V.), Campus Biomedico University, Roma, Italy.

^* To whom correspondence should be addressed. E-mail: masilvestrini{at}libero.it.

Background and Purpose--The aim of this study was to explore the possible contribution of alterations in cerebral hemodynamics to the evolution of cognitive impairment in patients with Alzheimer disease (AD).

Method--Fifty-three patients with AD were investigated. The evolution of cognitive decline over 12 months was evaluated by means of changes in Mini Mental State Examination (MMSE) and AD Assessment Scale for Cognition (ADAS-Cog) scores. Demographic characteristics, vascular risk profile, pharmacological treatment, and presence of white matter lesions were assessed at entry. Further, a basal evaluation of cerebrovascular reactivity to hypercapnia was measured with transcranial Doppler ultrasonography using the breath-holding index (BHI).

Results--Of all the variables considered, both MMSE and ADAS-Cog changes had the highest correlation with BHI, followed by age and diabetes. After subdividing both cognitive measures reductions into bigger and smaller-than-average decline (2 points for MMSE; 5 points for ADAS-Cog), multiple logistic regression indicated BHI as the sole significant predictor of cognitive decline.

Conclusions--These results show an association between impaired cerebral microvessels functionality and unfavorable evolution of cognitive function in patients with AD. Further research is needed to fully establish whether altered cerebral hemodynamics may be considered an independent factor in sustaining cognitive decline progression or an effect of pathological processes involved in AD.

Key words: dementia • hemodynamics • ultrasonography • ultrasonography, Doppler, transcranial

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