ENS 2009: Memory Complaints Predict Alzheimer's Disease but Not Vascular Dementia

Allison Gandey

July 07, 2009

July 7, 2009 (Milan, Italy) — Self-perceived memory impairment in the setting of white-matter changes may signal Alzheimer's, but, perhaps surprisingly, not vascular dementia, new study results suggest.

"We found that elderly subjects with white-matter changes complaining of memory problems had a higher risk of dementia," lead author Ana Verdelho, MD, from the Santa Maria Hospital at the University of Lisbon, in Portugal, told Medscape Neurology. "When we analyzed the subtypes of dementia, the risk of Alzheimer's disease was remarkable — 17-fold higher in the elderly complaining of memory difficulties."

"Interestingly, memory complaints showed quite different associations with dementia subtypes," coauthor Franz Fazekas, MD, from the Medical University of Graz, in Austria, added in a news release. "Self-perceived memory impairment was a predictor of Alzheimer dementia with vascular component, independent of other risk factors, but was not a predictor of vascular dementia."

Their findings, part of the European Leukoaraiosis and Disability (LADIS) study, were presented here at the 19th Meeting of the European Neurological Society.

Treat Vascular Risk Factors

Dr. Verdelho emphasizes that according to the group's findings, a memory complaint in an elderly patient with age-related white-matter changes can be an important sign of things to come. "What we see from these data is the complex interaction between vascular brain changes and a degenerative type of dementia, which should increase the awareness of the importance of treating vascular risk factors and possibly also help find other options to prevent age-related cerebral white-matter changes."

"This is a little bit surprising," William Thies, PhD, chief medical and scientific officer at the Alzheimer's Association, said during an interview. "We might have expected to see more vascular dementia, but what they found was more Alzheimer's disease."

Dr. Thies said this is a big study from a "quality group." He also applauded those who participated in the trial because the study required commitment with frequent monitoring over a long period of time. "This would not have been the easiest study to be a part of," he said.

The LADIS Study

"The LADIS study examines brain white-matter changes and their influence on the intellectual and motor abilities of aging people," Dr. Fazekas noted. The prospective 3-year study includes medical centers in 11 countries.

Patients were enrolled because of minor neurological, cognitive, or motor complaints or incidental findings on cranial imaging. These problems had no reported impact on daily living.

Investigators evaluated patients at baseline and yearly with a comprehensive clinical and functional protocol including a neuropsychological battery, an evaluation for depression, and questions on memory complaints.

At each follow-up visit, investigators classified patient cognitive status as demented, cognitively impaired without dementia, and not cognitively impaired.

Investigators conducted magnetic resonance imaging at entry and at the end of the study. They rated white-matter changes according to the Fazekas scale. And to assess predictors of dementia and dementia subtypes, they used survival Cox regression analysis.

As part of the analysis presented at the meeting, researchers looked at 639 patients. After 3 years, 90 people had become demented. Of those, there were 34 cases classified as Alzheimer dementia with a vascular component, 54 had vascular dementia, and 2 had frontotemporal dementia. Another 147 patients showed some cognitive impairment, but not dementia.

"What seems to be clear," Dr. Thies said, "is if there is damage to the brain, patients will show symptoms sooner."

The researchers have disclosed no relevant financial relationships.

19th Meeting of the European Neurological Society: Abstract O153. Presented June 23, 2009.

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