Cerebrovascular Reactivity Impairment in Preclinical Alzheimer's Disease
Cerebrovascular Reactivity Impairment in Preclinical Alzheimer's Disease
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DOI：
10.1111/jon.12606
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发表时间：
2019-07-01
影响因子：
2.4
通讯作者：
Bashford, Greg
中科院分区：
文献类型：
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作者：
Alwatban, Mohammed;Murman, Daniel L.;Bashford, Greg
背景和目的：脑血管反应性（CVR）下降和症状性阿尔茨海默病（AD）之间存在大量重叠。CVR可以使用经颅多普勒（TCD）测量大脑中动脉（MCA）中的脑血流速度（CBFV）进行量化，CO2作为血管舒张刺激。屏气加速度指数（BHAI）是我们实验室最近开发的一种新的、更可靠的CVR测量方法。我们的主要目标是探索使用TCD无症状AD screening.METHODS的可能性：一个试点研究人群被分为三组：9名健康对照组，8名被确定为临床前AD，10例被诊断为前驱或轻度AD。对照受试者在淀粉样蛋白正电子发射断层扫描（PET）成像上的临床痴呆评级（CDR）评分为0而没有淀粉样蛋白-β（A β）升高，临床前AD受试者的CDR = 0而A β升高，前驱至轻度AD受试者的CDR评分>= 0.5且A β升高。使用两个指数计算CVR：常规屏气指数（BHI）和新的BHAI。结果：BHAI能够区分9名正常对照组和8名临床前AD组，具有高度统计学意义（P <0.001）。BHI和搏动指数仅能区分AD与健康和临床前受试者（P < .001）。结论：在这项探索性初步研究中，与健康组相比，临床前、前驱期和轻度AD受试者的CVR显著降低。使用新的BHAI指数而不是传统的BHI指数检测到临床前AD组的较低CVR。
BACKGROUND AND PURPOSE: A substantial overlap exists between declines in cerebral vasoreactivity (CVR) and symptomatic Alzheimer's disease (AD). CVR can be quantified using transcranial Doppler (TCD) measurement of cerebral blood flow velocities (CBFV) in the middle cerebral artery (MCA) with CO2 as a vasodilatory stimulus. The breath-hold acceleration index (BHAI) is a new, more reliable measure of CVR developed recently in our laboratory. Our primary goal is to explore the possibility of using TCD for asymptomatic AD screening.METHODS: A pilot study population was divided into three groups: 9 healthy control subjects, 8 subjects identified as preclinical AD, and 10 patients diagnosed with prodromal or mild AD. Control subjects had a Clinical Dementia Rating (CDR) score of 0 without elevated amyloid-beta (A beta) on amyloid positron emission tomography (PET) imaging, preclinical AD subjects had CDR = 0 with elevated A beta, and prodromal to mild AD subjects had CDR scores >=.5 and elevated A beta. CVR was calculated using two indices: the conventional breath-holding index (BHI) and the new BHAI. TCD parameters between the three groups were compared.RESULTS: BHAI was able to distinguish between 9 normal control subjects and 8 preclinical-AD subjects with high statistical significance (P < .001). BHI and pulsatility index were able only to distinguish AD from healthy and preclinical subjects (P < .001).CONCLUSIONS: In this exploratory pilot study, CVR was significantly decreased in preclinical, prodromal, and mild AD subjects as compared to the healthy group. Lower CVR in the preclinical AD group was detected using the new BHAI index but not the conventional BHI index.