Abstract

The research is devoted to the clinical study of disorders in cerebral blood flow and microcirculatior in the development of Alzhelmer's disease in comparison with other neurodegenerative and ischemic diseases.

Materials and methods: 1117 patients with various types and stages of neurodegenerative ancischemic diseases were examined. 93 (8.33%) of them had various stages of Alzhelmer's disease - Test Group. Other 1024 (91.67%) had different types and stages of other cerebral neurodegenerative and ischemic lesions - Control Group. Control Group patients were divided: 23 (2.25%) suffered from Binswanger disease; 55 (5.37%) suffered from vascular Parkinsonism; 27 (2.64%) had initial signs of chronic cerebrovascular insufficiency of atherosclerotic origin; 577 (56.35%) had marked signs of chronic cerebrovascular insufficiency of atherosclerotic origin; 342 (33.40%) had a severe form of chronic cerebrovascular insufficiency accompanied by small-focal single or multiple strokes. Examination included: laboratory diagnostics, assessment of scales «The Clinical Dementia Rating scale» (CDR), «Mini-Mental State Examination» (MMSE), IB, cerebral scintiography (SG), rheoencephalography (REG), cerebral CT, MRI, MR angiography, digital angiography (DA).

Results: all patients with Alzheimer's disease, regardless of the stage of the disease, had a specific cerebral small vessel disease (CSVD) in temporal and frontoparietal regions, which manifests itself with dyscirculatory angiopathy of Alzheimer's type (DAAT), which is not found in control group patients.

Conclusions: DAAT is a specific to Alzheimer's disease lesion of cerebral angioarchitectonics and microvessels, which changes hemodynamics, causes cerebral hypoxia and contributes to disorders in beta-amyloid metabolism. The combination of deposition of amyloid beta in the cerebral tissue and the vascular wall, as well as specific microcirculation disorders, cause together neurodegeneration and the development of Alzheimer's disease. In patients with other neurodegenerative and ischemic diseases, CSVDs are of a different nature, with no DAAT phenomena observed.

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Abstract:

Aim. For determination of Alzheimer's disease (AD) stages, we offer a morphologically determined scale - The Tomography Dementia Rating scale (TDR) based on the severity of atrophic changes in the temporal lobes of the brain revealed during CT and MRI. Materials and methods. The research involved 140 patients aged 28-79. The Test Group included 81 patients aged 34-79 with AD various stages. The Control Group included 59 patients aged 28-78 with various types of brain lesions accompanied by manifestations of dementia and cognitive impairment, but not suffering from AD.

Results. CT and MRI data allowed to compose the TDR scale determining the severity of atrophic changes in the temporal lobes at each AD stage:

•          Pre-clinical AD stage TDR-0: temporal lobes atrophy with 4-8% tissue mass decrease (26-28 MMSE points).

•          Early AD stage - mild dementia TDR-1: temporal lobes atrophy with 9-18% tissue mass decrease (corresponds to CDR-1; 20-25 MMSE points).

•          Middle AD stage - mild dementia TDR-2: temporal lobes atrophy with 19-32% tissue mass decrease (corresponds to CDR-2; 12-19 MMSE points). 

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