Alzheimer’s v Vascular Dementia Can  you  tell the difference? Jonathan Waite Lings Bar Hospital  Nottingham
Alzheimer’s v Vascular <ul><li>Plaques </li></ul><ul><li>Tangles </li></ul><ul><li>Insidious onset </li></ul><ul><li>Progr...
Hachinski Score <ul><li>Abrupt onset    2 </li></ul><ul><li>Stepwise deterioration 1 </li></ul><ul><li>Fluctuating course ...
Evidence for mixed disorders <ul><li>Dementia in absence of cerebral infarction requires 8x greater tangle burden (Snowden...
Pathology in MRC-CFANS Non-demented Demented 5  /  35 27  /  29 26  /  21 43  /  15   Plaques 0  /  20 8  /  19 25  /  22 ...
MRC-CFANS - Vascular demented non-demented 33  /  46 64  /  75 31  /  37 76  /  81 Multiple pathologies Small vessel disea...
But… <ul><li>“ the lack of clear blue water between Alzheimer disease and vascular dementia is plainly acknowledged”  Brit...
Unimodal v Bimodal Alzheimer Mixed Vascular
Sir Martin Roth FRS 1917- <ul><li>Roth (1955) </li></ul><ul><li>The natural history of metal disorder in old age  </li></u...
Sir Martin Roth FRS 1917- <ul><li>Carney Roth & Garside  (1955) </li></ul><ul><li>The diagnosis of depressive symptoms and...
Endogenous v Reactive Endogenous Mixed Reactive
Bob Kendell 1935-2002 <ul><li>The Role of Diagnosis in Psychiatry (Oxford: Blackwell 1975) </li></ul>
Psychotic v Endogenous Depression <ul><li>Roth </li></ul><ul><li>Bimodal distribution </li></ul><ul><li>Two separate disor...
Alzheimer’s v Vascular Alzheimer Mixed Vascular
Risk factors for Alzheimer’s Disease <ul><li>Diabetes  (Stewart 1998) </li></ul><ul><li>Midlife   hypertension  (Elias  et...
Risk factors for Vascular Dementia <ul><li>Diabetes  (Desmond  et al  1993) </li></ul><ul><li>Midlife   hypertension  (Lin...
Cholinesterase Inhibitors <ul><li>Response to ChEI in vascular dementia  </li></ul><ul><li>Galantamine  (Erkinjuntti et al...
Natural History <ul><li>? Recent studies </li></ul><ul><li>Christie (1985) – no significant differences between diagnostic...
Understanding Vascular Dementia <ul><li>Hearts & Brains </li></ul><ul><li>Mind Your Head </li></ul><ul><li>www.alzheimers....
Conclusions <ul><li>Consider vascular risk factors in Alzheimer’s Disease </li></ul><ul><li>Consider Alzheimer’s Disease i...
Upcoming SlideShare
Loading in...5
×

Alzheimer's v Vascular Dementia Can you tell the difference?

564

Published on

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
564
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
16
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Alzheimer's v Vascular Dementia Can you tell the difference?

  1. 1. Alzheimer’s v Vascular Dementia Can you tell the difference? Jonathan Waite Lings Bar Hospital Nottingham
  2. 2. Alzheimer’s v Vascular <ul><li>Plaques </li></ul><ul><li>Tangles </li></ul><ul><li>Insidious onset </li></ul><ul><li>Progressive deterioration </li></ul><ul><li>Infarction </li></ul><ul><li>Sudden onset </li></ul><ul><li>Stepwise deterioration </li></ul><ul><li>Focal signs and symptoms </li></ul><ul><li>Pathological emotionalism </li></ul>
  3. 3. Hachinski Score <ul><li>Abrupt onset 2 </li></ul><ul><li>Stepwise deterioration 1 </li></ul><ul><li>Fluctuating course 2 </li></ul><ul><li>Nocturnal confusion 1 </li></ul><ul><li>Personality preservation 1 </li></ul><ul><li>Depression 1 </li></ul><ul><li>Somatic complaints 1 </li></ul><ul><li>Emotional </li></ul><ul><li>incontinence 1 </li></ul><ul><li>Hypertension 1 </li></ul><ul><li>Strokes 2 </li></ul><ul><li>Vascular disease 1 </li></ul><ul><li>Focal signs 2 </li></ul><ul><li>Focal symptoms 2 </li></ul>< = 4 Alzheimer’s Disease, > 7 Multi-Infarct Dementia
  4. 4. Evidence for mixed disorders <ul><li>Dementia in absence of cerebral infarction requires 8x greater tangle burden (Snowden et al 1997) </li></ul><ul><li>Only 13% patients clinically diagnosed as having VaD had pure VaD at PM (50% pure AD, 37% mixed) (Nolan et al 1998) </li></ul><ul><li>>40% of patients meeting vascular dementia criteria have AD pathology (Kalaria 2003) </li></ul><ul><li>Only 21% of Alzheimer cases have pure AD pathology (MRC-CFANS Ince 2004) </li></ul>
  5. 5. Pathology in MRC-CFANS Non-demented Demented 5 / 35 27 / 29 26 / 21 43 / 15 Plaques 0 / 20 8 / 19 25 / 22 66 / 39 Tangles Severe Mod Mild None 5 3 1 0 CERAD
  6. 6. MRC-CFANS - Vascular demented non-demented 33 / 46 64 / 75 31 / 37 76 / 81 Multiple pathologies Small vessel disease Infarcts Any
  7. 7. But… <ul><li>“ the lack of clear blue water between Alzheimer disease and vascular dementia is plainly acknowledged” British Journal of Psychiatry (2002) 180 97-98 </li></ul>
  8. 8. Unimodal v Bimodal Alzheimer Mixed Vascular
  9. 9. Sir Martin Roth FRS 1917- <ul><li>Roth (1955) </li></ul><ul><li>The natural history of metal disorder in old age </li></ul><ul><li>Blessed, Tomlinson & Roth (1968) </li></ul><ul><li>The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects </li></ul><ul><li>Roth & Wischik (1985) </li></ul><ul><li>Heterogeneity in senile dementia </li></ul>
  10. 10. Sir Martin Roth FRS 1917- <ul><li>Carney Roth & Garside (1955) </li></ul><ul><li>The diagnosis of depressive symptoms and the prediction of ECT response </li></ul>
  11. 11. Endogenous v Reactive Endogenous Mixed Reactive
  12. 12. Bob Kendell 1935-2002 <ul><li>The Role of Diagnosis in Psychiatry (Oxford: Blackwell 1975) </li></ul>
  13. 13. Psychotic v Endogenous Depression <ul><li>Roth </li></ul><ul><li>Bimodal distribution </li></ul><ul><li>Two separate disorders </li></ul><ul><li>Kendell </li></ul><ul><li>Unimodal distribution </li></ul><ul><li>Single disorder with distinctive psychopathology at extremes of continuum </li></ul>
  14. 14. Alzheimer’s v Vascular Alzheimer Mixed Vascular
  15. 15. Risk factors for Alzheimer’s Disease <ul><li>Diabetes (Stewart 1998) </li></ul><ul><li>Midlife hypertension (Elias et al 1993) </li></ul><ul><li>Smoking (Ott et al 1998, Launer et al 1999) </li></ul><ul><li>Atrial fibrillation ( Stewart et al 1999) </li></ul><ul><li>Stroke (Kalaria & Skoog 2000) </li></ul><ul><li>Cholesterol (Notkola et al 1998, Kivipelto et al 2001) </li></ul>
  16. 16. Risk factors for Vascular Dementia <ul><li>Diabetes (Desmond et al 1993) </li></ul><ul><li>Midlife hypertension (Lindsay et al 1997 ) </li></ul><ul><li>Smoking (Meyer et al 1988) </li></ul><ul><li>Atrial fibrillation ( Stewart et al 1999) </li></ul><ul><li>Stroke (Blessed et al 1968) </li></ul><ul><li>Cholesterol (Moroney et al 1999) </li></ul>
  17. 17. Cholinesterase Inhibitors <ul><li>Response to ChEI in vascular dementia </li></ul><ul><li>Galantamine (Erkinjuntti et al 2002) </li></ul><ul><li>Donepezil (Black et al 2003) </li></ul>
  18. 18. Natural History <ul><li>? Recent studies </li></ul><ul><li>Christie (1985) – no significant differences between diagnostic groups </li></ul>
  19. 19. Understanding Vascular Dementia <ul><li>Hearts & Brains </li></ul><ul><li>Mind Your Head </li></ul><ul><li>www.alzheimers.org.uk </li></ul>
  20. 20. Conclusions <ul><li>Consider vascular risk factors in Alzheimer’s Disease </li></ul><ul><li>Consider Alzheimer’s Disease in patients with vascular disorders </li></ul>
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×