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.

References

1.     2019 Alzheimer's disease facts and figures. J Alzheimer’s & Dementia 2019; 13(4): 325-373.

2.     Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010; 9 (7): 689-701.

3.     Cai Z., Wang C., He W. et al. Cerebral small vessel disease and Alzheimer's disease. Clin Interv Aging. 2015; 23 (10):1695-1704.

4.     Grammas P,  Martinez  J., Sanchez, A. et al. A new paradigm for the treatment of Alzheimer's disease: targeting vascular activation. J Alzheimers Dis. 2014; 40(3):619-630.

5.     Gjulev, N.M., Pustozertsev, V.G., Gjulev, S.N. Cerebrovascular Diseases. The Neva Dialect 2002.[In Russ.] 

6.     Mormino E.C., Papp K.V., Rentz D.M., et al. Early and late change on the preclinical Alzheimer's cognitive composite in clinically normal older individuals with elevated amyloid-p. J Alzheimer's & Dementia. 2017;13 (9): 10041012.

7.     Jack C.R., Petersen R.C, Xu YC., et al. Prediction of AD with MRI-based Hippocampal Volume in Mild Cognitive Impairment. Neurology. 1999; 52 (7): 1397-1403.

8.     Waldemar G., Dubois B., Emre M., et al. Recommendations for the diagnosis and management of Alzheimer’s disease and other disorders associated with dementia: EFNS guideline. European Journal of Neurology. 2007; 14, (1): e1-26.

9.     Burton E.J., Barber R., Mukaetova-Ladinska E.B., et al. Medial temporal lobe atrophy on MRI differentiates Alzheimer's disease from dementia with Lewy bodies and vascular cognitive impairment: a prospective study with pathological verification of diagnosis. Brain. 2009; 132 (Pt1): 195-203.

10.   Trojanowski J.Q., Vandeerstichele H., Korecka M., et al. Update on the biomarker core of the Alzheimer’s Disease Neuroimaging Initiative subjects. J Alzheimer’s & Dementia. 2010; 6 (3): 230-238.

11.   Adriaase A., Sanz-Arigita E., Binnewijzend M., et al. Molecular markers of Alzheimer's Disease pathology and their relationship with default mode network integrity. J Alzheimer's & Dementia. 2011; 7 (4) S2-S3.

12.   Meyer PT., Hellwig S., Amtage F., et al. Dualbiomarker imaging of regional cerebral amyloid load and neuronal activity in dementia with PET and 11C-labeled Pittsburgh compound B J Nucl Med. 2011; 52 (3): 393-400.

13.   Weiner W.W., Veitch D.P, Aisen PS., et al. 2014 Update of the Alzheimer's Disease Neuroimaging Initiative: A review of papers published since its inception. Journal of Alzheimer’s & Dementi. 2015; 11(6) e1-e120.

14.   Chiang G.C., Insel Ph.S., Tosun D., et al. Identifying cognitively healthy elderly individuals with subsequent memory decline by using automated MR temporoparietal volumes. Radiology. 2011; 259 (3): 844-851.

15.   De la Torre J.C. Hemodynamic consequences of deformed microvessels in the brain in Alzheimer’s disease. Annals of New York Acadmy Sciences. 1997; 26: 75-91. 

16.   Kalaria R. Small vessel disease and Alzheimer’s dementia: Pathological considerations. Cerebrovascular Diseases. 2002:13: 48-52.

17.   Maksimovich I.V. Dyscirculatory Angiopathy of Alzheimer’s Type. Journal of Behavioral and Brain Science. 2011 1 (2): 57-68.

18.   Zlokovic B.V. Neurovascular pathways to neurodegeneration in Alzheimer’s disease and other disorders. Nature Reviews. Neuroscience. 2011; 3: 723-738.

19.   Maksimovich I.V. Vascular factors in Alzheimer’s disease. Health. 2012; 4 (9A): 735-742.

20.   Baloiannis S.J., Baloiannis I.S. The vascular factor in Alzheimer’s disease: A study in Golgi technique and electron microscopy. Journal of the Neurological Sciences. 2012; 322: 117-121.

21.   Baloyannis S.J. (2015) Brain capillaries in Alzheimer's disease. Hell J Nucl Med.2015; 1 (Suppl 1): 152.

22.   Iadecola C. Neurovascular regulation in the normal brain and in Alzheimer's disease. Nat Rev Neurosci. 2004; 5, (5): 347-360.

23.   Maksimovich I.V., Gotman L.N. Method of complex radiation diagnostics at preclinical and clinical stages of Alzheimer’s disease. Patent RF №. 2315559. 2006. [In Russ.]

24.   Maksimovich I.V., Gotmanm L.N., Masyuk S.M. Method of Determining Dimensions of Temporal Brain Lobes in Patients Suffering from Alzheimer’s Disease. Patent RF № 2306102. 2006. [In Russ.]

25.   Bell R.D., Zlokovic B.V. Neurovascular mechanisms and blood-brain barrier disorder in Alzheimer’s disease. Acta Neuropathologica. 2009; 118: 103-113.

26.   Koike M.A., Green K.N., Blurton-Jones M. Oligemic hypoperfusion differentially affects tau and amyloid-{beta}. Am J Pathol. 2010; 177: 300-310.

27.   Nelson A.R., Sweeney M.D., Sagare A.P, Zlokovic A. V. Neurovascular dysfunction and neurodegeneration in dementia and Alzheimer's disease. Biochim Biophys Acta. 2016; 1862, (5): 887-900.

28.   Kimbrough I.F., Robel S., Roberson E.D., Son- theimer H. (2015) Vascular amyloidosis impairs the glio- vascular unit in a mouse model of Alzheimer's disease. Brain, 2015; 138, (Pt 12): 3716-3733.

29.   Maksimovich I.V. Radiodiagnostics of Alzheimer’s disease. Diagnostics and Intervention Radiology. 2008; 4: 27-38. [In Russ.]

30.   Morris J.C. The Clinical Dementia Rating (CDR): Current Version and Scoring Rules. Neurology. 1993; 11 (43): 2412-2414.

31.   Folstein M.F., Folstein S.E., McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12 (3): 189-198.

32.   Maksimovich I.V. The tomography dementia rating scale (TDR) - The rating scale of Alzheimer’s disease stages. Health. 2012; 4 (9A): 712-719.

33.   De Lin M., Jackson E.F. Applications of Imaging Technology in Radiation Research. Radiat Res. 2012; 177 (4): 387-397. 

34.   Brown W.R., Thore C.R. Review: cerebral microvas- cular pathology in ageing and neurodegeneration. Neu- ropatholApplNeurobiol. 2011; 37 (1): 56-74.

35.   Henry-Feugeas M.C. Alzheimer’s disease in late- life dementia: a minor toxic consequence of devastating cerebrovascular dysfunction. Med Hypotheses. 2008; 70 (3): 866-875.

36.   Maksimovich I.V. Certain new aspects of etiology and pathogenesis of Alzheimer’s disease. Advances in Alzheimer’s Disease. 2012; 1 (3): 68-76.

37.   Maksimovich I.V. Disorders of cerebrovascular angioarchitectonics and microcirculation in the etiology and pathogenesis of Alzheimer’s disease Advances in Alzheimer’s Disease. 2013; 2, (4): 171-181.

38.   Zlokovic B.V. Neurodegeneration and the neurovascular unit. Nat Med. 2010; 16 (12): 1370-1371.

39.   Iadecola C. The overlap between neurodegenera- tive and vascular factors in the pathogenesis of dementia. Acta Neuropathol.2010 120 (3): 287-396.

40.   De la Torre J.C. A turning point for Alzheimer's disease? Bio Factors. 2012; 38 (2): 78-83.

41.   De la Torre J.C. Cerebral Perfusion Enhancing Interventions: A New Strategy for the Prevention of Alzheimer Dementia. Brain Pathology. 2016; 26 (5): 618-631.

42.   Love S., Miners J.S. Cerebral Hypoperfusion and the Energy Deficit in Alzheimer's Disease Brain Pathology. 2016; 26 (5): 607-617.

43.   Nielsen R.B., Egefjord L., Angleys H., et al. Capillary dysfunction is associated with symptom severity and neurodegeneration in Alzheimer's disease. J Alzheimer's & Dementia. 2017; 13 (10): 1143-1153. 4 4 . Bosco P., Redolfi A., Bocchetta M., et al. The impact of automated hippocampal volumetry on diagnostic confidence in patients with suspected Alzheimer's disease: An EADC study. J Alzheimer's & Dementia. 2017; 13 (9): 10131023.

45.   Iadecola C. Dangerous leaks: blood-brain barrier woes in the aging hippocampus. Neuron. 2015; 85 (2): 231-233.

46.   Montagne A., Barnes S.R., Sweeney M.D. et al. Blood-brain barrier breakdown in the aging human hippocampus. Neuron. 2015; 85 (2): 296-302.

47.   Maksimovich I.V. Morphometric Definition of Alzheimer's Disease Stages by Means of The Tomography Dementia Rating Scale (TDR). Brain Disord Ther. 2017; 6, (2): 1-4.

48.   Schmidtke K., Hull M. Cerebral small vessel disease: how does it progress? J Neurol Sci. 2005; 229-230: 13-20.

49.   Qureshi A.I., Caplan L.R. Intracranial atherosclerosis. Lancet. 2014; 15, 383 (9921), 984-998.

50.   Caplan L.R. The Effect of Small Artery Disease on the Occurrence and Management of Large Artery Disease. JAMA Neurol. 2016; 73 (1): 19-20.

51.   Ramos-Estebanez C., Moral-ArceI., Gonzalez- Mandly A. et al. Vascular cognitive impairment in small vessel disease: Clinical and neuropsychological features of lacunar state and Binswanger's disease. Age Ageing. 2011; 40 (2): 175-180. 

52.   AkiguchiI., Budka H., Shirakashi Y, et al. MRI features of Binswanger's disease predict prognosis and associated pathology. Ann Clin Transl Neurol. 2014; 1 (10): 813-821. 

53.   Maksimovich I.V. Possibilities of Application of Transcatheter Treatment of Vascular Dementia with Bin- swanger’s Disease. Global Journal of Health Science. 2017; 9 (6): 13-21.

Abstract:

Integrated approach to radiologic diagnostics of the Alzheimer's disease used in 87 patients, 42 of which were at risk or at different stages of the disease, and 45 patients had various cerebral pathology not connected to the Alzheimer's disease. Computed tomography (CT) with temporal lobe volume calculation followed by scintigraphy, rheoencephalography and digital subtractional angiography (DSA) were done in all the patients.

Temporal and hippocampal atrophy (1), fronto-parietal and temporal capillary vascular bed reduction (2) with multiple arteriovenous shunts (3), as well as venous congestion with anomalous fronto-parietal veins formation (4) were the characteristic radiological features of the Alzheimer's disease. It is important that the above were seen not only in patients with late, but also in early and preclinical stages. These phenomena were also shown to be specific for the Alzheimer disease.

Reference

1.     Винблад Б. Болезнь Альцгеймера: эпидемиология, экономические затраты и терапевтические стратегии. Болезнь Альцгеймера и старение: от нейробиологии к терапии. Материалы 2-й российской конференции 18-20 октября 1999 г. М.: Пульс. 1999; 24.

2.     Altzheimer's Disease Facts and Figures, 2007.A Statistical abstract of U. S. data on Altzeimer's disease published by the Altzheimer'sAssociation. М.: Washington. 2008; 1-30.

3.     Гаврилова С.И., Калын Я.Б., Брацун А.Л. Эпидемиологические аспекты болезниАльцгеймера и других деменций позднеговозраста. XII съезд психиатров России. М. 1995;424-425.

4.     Гаврилова С.И. Фармакотерапия болезниАльцгеймера. М.: Пульс. 2003; 337.

5.     Вавилов С.Б. Компьютерная томографияголовного мозга в психиатрии: методы морфометрии. Компьютерная томография и другие современные методы диагностики(возможности и перспективы). Материалымеждународного симпозиума. М. 1989; 60-67.

6.     Колыхалов И.В. Клинические и компьютерно-томографические сопоставления при деменциях альцгеймеровского типа. Автореф. дис. канд. мед. наук. М. 1993; 25.

7.     Ахадов Т.А., Тютин Л.А., Панов В.О. и др. Объемные поражения головного мозга. Клиническое применение магнитно-резонансной томографии с контрастным усилением. Опыт использования парамагнитного средства «Магневист». М.: Видар. 1996; 21-28.

8.     Дамулин И.В., Левин О.С., Яхно Н.Н. Болезнь Альцгеймера: клинико-МРТ-исследование. Неврологический журнал. 1999; 2: 34-38.

9.     Ойфа А.И. Патологический анализ компьютерно-томографических изменений мозга в геронтопсихиатрии. Независимый психологический журнал. 2003; 2: 68-73.

10.   Bradley W.G., Waluch V., Yadley R.A. et al. Comparison of CT and MR in 400 patients with suspected disease of the brain and cervical spinal cord. Radiology. 1984; 152: 695-702.

11.   Bowen B.C. et al. MR signal abnormalities in memory disorder and dementia. Am. J. Roentgenol. 1990; 6: 1285-1292.

12.   Tsuchiya K., Makita K., Furui S., Nitta K. MRIappearances of calcified lesions within intracranial tumors. Neuroradiology. 1993; 35:341-344.

13.   Tzika A.A., Robertson R.L., Barnes P.D. et al.Childhood moyamoya disease: hemodynamicMRI. Pediatr. Radiology. 1997; 27: 727-735.

14.   Rusinek H., de Leon M.J., George A.E. et al.Alzheimer disease: measuring loss of cerebralgray matter with MR imaging. Radiology. 1991;178: 109-114.

15.   Kesslak J.P., Nalcioglu O., Cotman C.W.Quantification of magnetic resonance scansfor hippocampal and parahippocampalatrophy in Alzheimer's disease. Neurology.1991; 41: 51-54.

16.   Jack C.R., Petersen R.C., Xu Y.C. et al. Medialtemporal atrophy on MRI in normal agingand very mild Alzheimer's disease. Neurology.1997; 49: 786-794.

17.   Jack C.R., Bentley M.D., Twomey C.K., Zinsmeister A.R. MR imaging-based volume measurements of the hippocampal formation andanterior temporal lobe: validation studies.Radiology. 1990; 176: 205-209.

18.   Jack C.R. Structural imaging approaches toAlzheimer's disease. Early diagnosis of Alzheimer's disease / ed. S. Daffner. Humana. N.J.2000.

19.   Kalaria R.N. Cerebral vessels in ageing andAlzheimer's disease. Pharmacol. Ther. 1996;3 (72): 193-214.

20.   Kalaria R.N. Small vessel disease and Alzheimer's dementia: pathological considerations.Cerebrovascular. Disies. 2002; 3 (2): 48-52.

21.   Rodriguez G., Vitali P., Calvini P. et al. Hippocampal perfusion in mild Alzheimer's disease.Psychiatry Res. 2000; 100: 65-74.

22.   Гаврилова С.И. Практическое руководствопо диагностике и лечению болезни Альцгеймера. М.: Медицина. 2002; 43.

23.   Жариков Г.А., Рощина И.Ф. Диагностикадеменции альцгеймеровского типа на ранних этапах ее развития. Психиатрия и психофармакотерапия. 2001; 2: 23-27.

24.   Максимович И.В., Овсянников С.А., ГотманЛ.Н. Особенности микроциркуляции головного мозга у лиц с повышенным рискомвозникновения и ранними стадиями болезни Альцгеймера. Ангиология и сосудистаяхирургия. 2004; 4: 20-21.

25.   Максимович И.В., Готман Л.Н., Масюк С.М.Транслюминальная лазерная ангиопластика в лечении микроциркуляторных нарушений при болезни Альцгеймера. Ангиология и сосудистая хирургия. 2004; 10 (3): 89-90.

26.   Максимович И.В., Готман Л.Н. Отдаленныерезультаты применения транслюминальной лазерной ангиопластики в леченииболезни Альцгеймера. Бюл. НЦССХ им.А.Н. Бакулева. 2005; 6 (3): 103.

27.   Максимович И.В., Масюк СМ. Динамические изменения кровоснабжения и микроциркуляции головного мозга у больных,страдающих болезнью Альцгеймера, в отдаленном периоде после проведения транслюминальной лазерной ангиопластики.Сердечно-сосудистые заболевания. Бюл.НЦССХ им. А.Н. Бакулева. 2007; 8: 197.

28.   Максимович И.В., Готман Л.Н. Способ комплексной лучевой диагностики доклинических и клинических стадий болезни Альцгеймера. № 2315559 Патент РФ. 2008.

29.   Максимович И.В., Готман Л.Н. Применение метода транслюминальной лазернойангиопластики в лечении болезни Альцгеймера. Бюл. НЦССХ им. А.Н. Бакулева. 2004;5 (10): 210-211.

30.   Максимович И.В., Готман Л.Н., Масюк С.М.Репоративные изменения головного мозгау больных, страдающих болезнью Альцгеймера, в отдаленном периоде после проведения транслюминальной лазерной ангиопластики. Бюл. НЦССХ им. А.Н. Бакулева.2006; 6 (3): 103.

31.   Максимович И.В., Готман Л.Н., Масюк С.М.Способ определения размера височныхдолей головного мозга при болезни Альцгеймера. № 2306102. Патент РФ. 2007.

32.   Пономарева Н.В., Селезнева Н.Д., Колыхалов И.В. Нейрофизиологические механизмы деятельности мозга при болезни Альцгеймера. Вопросы геронтопсихиатрии. М.:Медицина. 1991; 58-66.

33.   McKhann G., Drachman D., Folstein M. et al.Clinical diagnosis of Alzheimer's disease:report of the NINCDS-ADRDA WorkGroup under the auspices of Department ofHealth and Human Services Task Force onAlzheimer's Disease. Neurology. 1984; 7 (34):939-944.

34.   Mirra S.S., Gearing M., McKeel D.W. et al.Interlaboratory comparison of neuropathology assessments in Alzheimer's disease: a studyof the Consortium to Establish a Registry forAlzheimer's Disease (CERAD).J. Neuropathol.Exp. Neurol. 1994; 3 (53): 303-315.

35.   Corey-BloomJ.,Thal L., Galasko D. et al. Diagnosis and evaluation of dementia. Neurology.1995; 45: 211-218.

36.   Morris J.C. The Clinical Dementia Rating(CDR): current version and scoring rule.Neurology. 1993; 11 (43): 2412-2414.

           37.   Kesslak J.P., Nalcioglu O., Cotman C.W. Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer's disease. Neurology. 1991; 41: 51-54.

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). 

References

1.     Alzheimer’s Disease Facts and Figures, 2007. A Statistical Abstract of US Data on Alzheimer’s Disease published by the Alzheimer’s Association http://www.alz.org/national/documents/Report_2007FactsAndFigures.pdf.

2.     Alzheimer’s Disease Facts and Figures 2009 Alzheimer’s Association. http://www.alz.org/national/documents/report_alzfactsfigures2009.pdf.

3.     Alzheimer's Disease Facts and Figures

3.     2010 Alzheimer’s Association. http://www.alz.org/ documents_custom/report_alzfactsfigures2010.pdf.

4.     2011 Alzheimer’s Disease Facts and Figures. http://www.alz.org/downloads/facts_figures_2011.pdf.

5.     Generation Alzheimer’s: The Defining Disease of the Baby Boomers http://act.alz.org/site/Doc-Server/ALZ_BoomersReport.pdf/docID=521.

6.     Jun G., Naj F.C., Beecham G.W., et al. Meta-analysis confirms CR1, CLU, and PICALM as Alzheimer disease risk loci and reveals interactions with APOE genotypes. Arch. Neurol. 2010; 67 (12):1473-1484.

7.     Saykin A.J, Wishart H.A. Mild cognitive impairment: conceptual issues and structural and functional brain correlates. Seminars in Clinical. Neuropsychiatry. 2003; 8 (1): 12-30.

8.     Saykin A.J., Wishart H.A., Rabin L.A., et all. Older adults with cognitive complaints show brain atrophy similar to that of amnestic MCI. Neurology. 2006; 12 No. 67 (2): 834-842.

9.     Shen L., Fipri H.A., Saykin AJ.,West J.D. Parametric surface modeling and registration for comparison of manual and automated segmentation of the hippocampus. Hippocampus. 2009; 19 (6): 588-595.

10.   Maksimovich I.V. Vozmoznosti covremennoy kompiuternoy tomografii v diagnostike bolezni Alzheimra.[Possibilities of computed tomography in diagnostics of Alzheimer’s diseases.] Nevrologicheskiy vestnik .2009; 1: 5-10 [In Russ].

29.   Maksimovich I.V. Dyscirculatory Angiopathy of the Brain of Alzheimer's Type. Eurointerventional. 2011; 7: M 253.

30.   Maksimovich I.V. Endovascular Application of Low-Energy Laser in the Treatment of Dyscirculatory Angiopathy of Alzheimer’s Type. Journal of Behavioral and Brain Science. 2012; 2 (1): 67-81.

11.   Mayeux R., Reitz C., Brickman A.M., Haan M.N., Manly J.J. et. all. “Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Part 1. Alzheimers & Dementia. 2011; 7 (1): 15-34.

12.   Seashadri S., Beaser A., Au R., Volf P.A., Evans D.A. et.al. Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Part 2. Alzheimers & Dementia. 2011; 7 (I): 35-52.

13.   2012 Alzheimer’s Disease Facts and Figures. http://www.alz.org/downloads/facts_figures_2012.pd.

14.   National Plan to Address Alzheimer's Disease http: / /www.whitehouse.gov/ blog/2012/05/17/national-plan-address- alzheimers-disease.

15.   Morris J.C. The clinical dementia rating (CDR): current version and scoring rule. Neurology. 1993; 43 (II):2412-2414.

16.   Maksimovich I.V. Gotman L.N. Sposob kompleksnoy luchevoy diagnostiki doklinicheskih I klinicheskih stadiy bolezni Alzheimera. [Method of complex beam-diagnostics of subclinical and clinicas stages of Alzheimer’s disease.] Russian patent, №. 2315559 [In Russ].

17.   Maksimovich I.V., Gotman L.N., Masiuk S.M. Sposob opredelenia razmera visochnich doley golovnogo mozga pri bolezni Alzheimera [Measuring the size of the temporal lobes in patients with Alzheimer's disease] Russian patent № 2306102 [In Russ].

18.   Maksimovich I.V. Luchevaia diagnostika bolezni Alzheimera. [Beam-diagnostics of Alzheimer’s disease.] Diagnosticheskaia i intervencionnaia radiologia [Diagnostic and interventional radiology. ]. 2008; 2 (4): 27-38 [In Russ].

19.   Maksimovich I.V. Dyscirculatory Angiopathy of Alzheimer's Type. Journal of Behavioral and Brain Science. 2011; 1 (2): 57-68.

20.   Dickerson B.C. Functional magnetic resonance imaging of cholinergic modulation in mild cognitive impairment. Current Opinion in Psychiatry. 2006; 19: 299-306.

21.   Chiang G.C., Insel Ph.S, Tosun D., Schuff N., Truran-Sacrey D., Raptentsetsang S., Jack C.R., Weiner M.W. Identifying cognitively healthy elderly individuals with subsequent memory decline by using automated MR temporoparietal volumes. Radiolog. 2011; 259 (3): 844-51.

22.   Schuff N., Insel Ph., Chiang G., Truran D, Gamst A., Jack C., Aisen P., Petersen R., Shaw L., Trojanowski J., Weiner M. Acceleration of brain atrophy rates with advancing cognitive deterioration from normal aging to MCI to Alzheimer's disease. J. Alzheimer's &Dementia. 2011; 7 (4): S223.

23.   Trojanowski J.Q., Vandeerstichele H., KoreckaM., et all. Update on the biomarker core of the Alzheimer's Disease Neuroimaging Initiative subjects. Alzheimer's & Dementi. 2010; 6 (3): 230-238.

24.   Meyer P.T., Hellwig S., Amtage F., et al. Dual-biomarker imaging of regional cerebral amyloid load and neuronal activity in dementia with PET and 11C-labeled Pittsburgh compound B. J. Nucl. Med. 2011; 52 (3): 393-400.

25.   Perrin R.J., Craig-Schapiro R., Morris J.C., et al. Identification and validation of novelcerebrospinal fluid biomarkers for staging early Alzheimer's disease. Public Library of Science On. 2011; 12 (6): e16032.

26.   Jack C., Vemuri P., Viste H., et al. Ordering of Alzheimer's disease biomarkers. Alzheimer's & Dementia. 2011; 7 (4): S4-S5.

27.   Mayeux R., Reitz C., Brickman A.M., Haan M.N., ManlyJ.J. et. al. Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Part 1. Alzheimers & Dementia. 2011; 7 (1): 15-34.

28.   Folstein M.F., Folstein S.E., McHugh P.R. Minimental state. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975; 12 (3): 189-98.

29.   Maksimovich I.V. Dyscirculatory Angiopathy of the Brain of Alzheimer's Type. Eurointerventional. 2011; 7: M 253.

30.   Maksimovich I.V. Endovascular Application of Low-Energy Laser in the Treatment of Dyscirculatory Angiopathy of Alzheimer’s Type. Journal of Behavioral and Brain Science. 2012; 2 (1): 67-81. 

Abstract:

The author presents the endovascular technique for treatment of the Alzheimer disease. 40 patients aged 34–78 years were included into the study 4 of them were at risk, 13 had early and moderate stage, 16 – full-scaled stage, and 7 had preterminal stage of the disease.

The survey design included computed tomography with temporal lobes volume calculation, brain scintigraphy, rheoencephalography, and digital cerebral angiography.

Temporal lobes atrophy and capillary flow reduction in fronto-parietal and temporal regions are shown to be the characteristic radiomorphological features of the Alzheimer disease. Indications and contrindications for the treatment are presented.

Interventions were pefformed in terms of 1 to 12 years after the disease manifestation. The aim of treatment was percutaneous revascularization and capillary bed restoration by means of transluminal low-energy laser.

Clinical improvement was seen in all the cases; however, it differed in each group of patients. Thus, it is possible not only suspend the advancement of the Alzheimer disease, but to achieve its regression, with regeneration of the brain tissues and to return the people into the active life.  

References 

1.        Винблад Б. Болезнь Альцгеймера: эпидемиология, экономические затраты и терапевтические стратегии. Материалы 2-й российской конференции «Болезнь Альцгеймера и старение: от нейробиологии к терапии» 18–20 октября 1999 г. М.: Пульс. 1999; 24.  

2.        Alzheimer’s Disease Facts and Figures 2007. A Statistical Abstract of US Data on Alzheimer’s Disease published by the Alzheimer’s Association. Washington. 2008; 1–30.

3.        Гаврилова С.И., Калын Я.Б., Брацун А.Л. Эпидемиологические аспекты болезни Альцгеймера и других деменций позднего возраста. XII съезд психиатров России. М. 1995; 424–425.

4.        Гаврилова С.И. Практическое руководство по диагностике и лечению болезни Альцгеймера. М.: Медицина. 2002; 43.  

5.        Galasko D. New approaches to diagnose and treat Alzheimer’s disease: a glimpse of the future. Clin. Geriatr. Med. 2001; 17 (2): 393–410.  

6.        Tsuchiya K., Makita K., Furui S., Nitta K. MRI appearances of calcified lesions within intracranial tumors. Neuroradiology. 1993; 35: 341–344.  

7.        Tzika A.A., Robertson R.L., Barnes P.D. et al. Childhood moyamoya disease: hemodynamic MRI. Pediatr. Radiology. 1997; 27: 727–735.  

8.        Rusinek H., de Leon M.J., George A.E. et al. Alzheimer disease: measuring loss of cerebral gray matter with MR imaging. Radiology. 1991; 178: 109–114.  

9.        Kesslak J.P., Nalcioglu O., Cotman C.W. Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer’s disease. Neurology. 1991; 41: 51–54.  

10.      Жариков Г.А., Рощина И.Ф. Диагностика деменции альцгеймеровского типа на ранних этапах ее развития. Психиатрия и психофармакотерапия. 2001; 2 (2): 3–27.

11.      Гаврилова С.И. Фармакотерапия болезни Альцгеймера. М.: Пульс. 2003; 337.  

12.      Grundman M. Current therapeutic advances in Alzheimer’s disease. In: Research and practice in Alzheimer’s disease. Paris. 2001; 5: 172–177.  

13.      Jacobsen J.S., Reinhart P., Pangalos M.N. Current Concepts in Therapeutic Strategies Targeting Cognitive Decline and Disease Modification in Alzheimer’s Disease. Neuro Rx. 2005; 2: 612–626.

14.      Wilkinson D. Drugs for treatment of Alzheimer’s disease. Int. J. Clin. 2001; 55 (2): 129–134.  

15.      Masse I., Bordet R., Deplanque D. et al. Lipid lowering agents are associated with a slower cognitive decline in Alzheimer’s disease. J. of Neurol., Neurosurg. and Psych. 2005; 76: 1624–1629.