HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Data Supplement Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Deschaintre, Y. Articles by Pasquier, F. PubMed PubMed Citation Articles by Deschaintre, Y. Articles by Pasquier, F. Related Collections Stroke prevention Clinical trials Observational study (Cohort, Case control) Alzheimer's disease

Treatment of vascular risk factors is associated with slower decline in Alzheimer disease

From the Université Lille Nord de France (Y.D., F.P.), EA 2691, Centre Mémoire de Ressources et de Recherche, CHRU de Lille; Stroke Team (Y.D.), Centre Hospitalier de l’Université de Montréal; Université Lille Nord de France (F.R.), INSERM, UMR744, Institut Pasteur de Lille; and Université Lille Nord de France (D.L.), EA 2691, Service de neurologie vasculaire, CHRU de Lille, France.

Address correspondence and reprint requests to Dr. Florence Richard, Université Lille Nord de France, INSERM UMR 744, Institut Pasteur de Lille, 1 rue Calmette, 59019 Lille Cedex, France florence.richard{at}pasteur-lille.fr

Background: There is growing evidence that vascular risk factors (VRF) contribute to cognitive decline. Whether their treatment can slow down the progression of Alzheimer disease (AD) remains unsettled. The aim of this observational study was to evaluate whether the treatment of VRF is associated with a slower cognitive decline in patients who have AD without cerebrovascular disease (CVD).

Methods: We recruited 301 consecutive patients who had AD without CVD (mean age 71.7 years; 69.4% women; first Mini-Mental State Examination [MMSE] mean score 21.6; mean follow-up 2.3 years), who had attended a memory clinic between 1997 and 2003. VRF sought were high blood pressure, dyslipidemia, diabetes mellitus, tobacco smoking, and atherosclerotic disease. Only 21 patients (7.0%) had no VRF. Others were classified as having no VRF treated (n = 72; 25.7%), some VRF treated (n = 119; 42.5%), or all VRF treated (n = 89; 31.8%). We compared MMSE progression over time among these 3 groups using a mixed random effects regression model.

Results: Baseline MMSE scores were similar in the 3 groups. With adjustment for confounding factors, MMSE progression over time differed significantly between groups (p = 0.002). Patients with all their VRF treated declined less than those with none of their VRF treated. Those with some VRF treated tended to have an intermediate decline.

Conclusions: In patients who have Alzheimer disease without CVD, treatment of vascular risk factors (VRF) is associated with a slower decline in Mini-Mental State Examination score. Randomized controlled trials are needed to confirm this association, but our data suggest that dementia should not prevent treatment of VRF.

Abbreviations: AD = Alzheimer’s disease; ANOVA = analysis of variance; ChEI = cholinesterase inhibitor; CVD = cerebrovascular disease; DRS = Dementia Rating Scale; MMSE = Mini-Mental State Examination; RR = relative risk; VRF = vascular risk factors.

Supplemental data at www.neurology.org

Supported in part by fellowship grants from the Fondation du CHUM and the Centre de prévention des maladies neurovasculaires du CHUM (Y.D.) and by a grant from the French Ministry of Health (mainly by a Programme Hospitalier de Recherche Clinique grant: PHRC 2001 R1909).

Disclosure: Author disclosures are provided at the end of the article.

Presented in part as an oral presentation at the International Conference on Prevention of Dementia, Washington, DC, June 2007.

Received January 27, 2009. Accepted in final form May 4, 2009.