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.