ENS 2010: Dementia Study: New Insights Into Changes In The Brain Offer The Possibility Of Targeted Early Diagnosis And Prevention

The development of vascular dementia, the most common form of dementia after Alzheimer's dementia, may soon be able to be diagnosed before the first appearance of cognitive symptoms, and could be stopped or at least slowed down by targeted preventative measures. This has been demonstrated by partial results from the large-scale multinational LADIS study (Leukoaraiosis And DISability study) presented today at the 20th Annual Meeting of the European Neurological Society (ENS) in Berlin. The research group could demonstrate that specific changes in the so-called "white matter" in the deep parts of the brain are linked to a significantly higher risk of succumbing to vascular dementia within the next three years.


Disrupted connectivity


Vascular dementia develops, in contrast to Alzheimer's dementia, through pathological changes to blood vessels as a result of high blood pressure, diabetes, high blood fat levels or smoking. While Alzheimer's disease primarily affects memory, vascular dementia causes abnormalities of the so-called executive brain functions reliant on the connectivity of many regions of the brain - affecting for example the ability to judge the cost/benefit relation of an offer and to make appropriate decisions. White brain matter is responsible for global functioning of this sort.


Specific symmetrical changes which can be detected with high resolution magnetic resonance imaging (MRI) in white matter, the so-called leukoaraiosis, occur with increasing frequency from the age of 60 and can be associated with dementia. The results from the latest studies demonstrate that it is not leukoaraiosis severity alone, but also the exact location of its occurrence which is decisive for the prognosis.


Leukoaraiosis in the brain as a dementia predictor


639 subjects without dementia aged from 65 to 84 were investigated for the extent and location of changes in white matter and were then observed for the following three years. 90 of the subjects developed various forms of dementia during this period, primarily vascular dementia, Alzheimer's dementia and a mixed form of the two. "It was demonstrated that periventricular leukoaraiosis was an independent indicator for the development of dementia and should not be considered a symptom of old age only. However people at the beginning of the study in whom changes had occurred in white matter in the deeper regions of the brain, especially in the subcortical brain, developed vascular dementia significantly more frequently," says Dr. Bruno Miranda (University Hospital de Santa Maria, Lisbon), the main author of the study.


Hope for early detection and new prevention strategies


"This finding deepens our understanding of vascular dementia," says the expert. "We can hope to build on this so that we are able in future to earlier detect and better prevent this form of mental decline which is so agonizing to those affected and their families. Further studies will demonstrate whether we can help people with leukoaraiosis in deep brain regions by aggressive treatment of the underlying diseases such as high blood pressure or diabetes to a better prognosis and prevent or at least delay the outbreak of vascular dementia."


Source:
European Neurological Society