
Alzheimer's disease (AD) and stroke are two conditions that are often found to coexist. However, the link between the two is complex and not yet fully understood. While decline in cognitive functions could be a result of underlying cerebrovascular damage, it is unclear whether cerebrovascular changes are a cause or an effect of AD.
Stroke is a brain disease that occurs when there is an interruption to the blood supply to the brain, resulting in reduced oxygen supply to neurons. This can be caused by a clot blocking a blood vessel (ischaemic stroke) or a burst blood vessel (haemorrhagic stroke). Stroke is the second leading cause of death and the third leading cause of disability-adjusted life-years worldwide. The risk of having a stroke increases with age, but it can occur at any time.
AD is a multifactorial neurodegenerative disease characterised by memory loss, multiple cognitive impairments and progressive degeneration of behavioural and functional capacities. AD accounts for more than 80% of dementia cases worldwide in people older than 65. Type 2 diabetes, traumatic brain injury and ischaemic stroke are contributing factors for the development of AD.
Research has shown that patients with AD are more likely to be vulnerable to complications associated with cerebrovascular diseases. They are also more likely to be disabled or die during hospitalisation. Compared with non-AD controls with similar risk profiles, patients with AD have a relative risk of 1.42 for haemorrhagic stroke and 1.15 for ischaemic stroke.
Characteristics | Values |
---|---|
Risk factors | Age, sex, race, ApoE4 genotype, Down syndrome, mutations in APP, PS1 and PS2 genes, and polymorphisms in BINI, CLU, ABCA7, CR1, PICALM genes |
Modifiable risk factors | Diet, physical and mental activities, cardiovascular, hypertension, smoking, diabetes, obesity, metabolic syndrome, depression and traumatic brain injury |
Incidence rate of stroke in patients with AD | 15.4/1000 person-years |
Incidence rate of ischemic stroke in patients with AD | 13.0/1000 person-years |
Incidence rate of ICH in patients with AD | 3.4/1000 person-years |
Relative risk of hemorrhagic stroke in patients with AD | 1.42 |
Relative risk of ischemic stroke in patients with AD | 1.15 |
What You'll Learn
- The risk of stroke increases with age, but it can occur at any age
- Stroke is the second leading cause of death and the third leading cause of disability-adjusted life-years worldwide
- Alzheimer's disease is the most prevalent neurodegenerative disease leading to dementia
- Alzheimer's disease and stroke often coexist
- The risk of hemorrhagic stroke is higher in patients with Alzheimer's disease compared to non-Alzheimer's controls with similar risk profiles
The risk of stroke increases with age, but it can occur at any age
Stroke is a brain disease that can occur at any age, but the risk of having a stroke increases with age, particularly after the age of 55. It is the second leading cause of death and the third leading cause of disability-adjusted life-years worldwide.
A stroke occurs when there is an interruption to the supply of blood to the brain, resulting in reduced oxygen supply to neurons. This interruption is commonly caused by a blood clot blocking a blood vessel (ischaemic stroke) or a burst blood vessel (haemorrhagic stroke).
There are modifiable risk factors that can be controlled through pharmacological or surgical interventions and lifestyle changes, including diet, physical and mental activities, cardiovascular health, hypertension, smoking, diabetes, obesity, metabolic syndrome, depression, and traumatic brain injury.
However, there are also non-modifiable risk factors, including age, sex, race, genetics, and Down syndrome.
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Stroke is the second leading cause of death and the third leading cause of disability-adjusted life-years worldwide
Stroke is a leading cause of serious long-term disability and death worldwide. Every year, over 12 million people suffer from stroke worldwide; of these, 6.5 million will die. The incidence of stroke is increasing due to ageing populations. In addition, more young people are affected by stroke in low- and middle-income countries. Ischaemic stroke is more frequent but haemorrhagic stroke is responsible for more deaths and disability-adjusted life-years lost.
Stroke is preventable and treatable. Modifiable risk factors include hypertension, smoking, diabetes, atrial fibrillation, diet, physical and mental activities, cardiovascular health, obesity, metabolic syndrome, and traumatic brain injury. Non-modifiable risk factors include age, sex, ethnicity, and heredity.
Recent research has also revealed that stroke is a major factor for vascular dementia and Alzheimer's disease. This is due to the biochemical dysfunction in the brain caused by cerebral abnormalities, particularly ischaemic stroke.
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Alzheimer's disease is the most prevalent neurodegenerative disease leading to dementia
Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder leading to dementia. It is characterised by a progressive impairment of behavioural and cognitive functions, including memory, comprehension, language, attention, reasoning, and judgement. The global prevalence of dementia was reported to be 20.3 million in 1990, rising to 43.8 million in 2016, and is expected to reach 150 million by 2050.
AD is a multifactorial condition with many known risk factors, the most significant of which is age, with advancing age being the primary contributor. Other risk factors include cardiovascular diseases, obesity, diabetes, traumatic head injury, depression, higher parental age at birth, smoking, family history of dementia, and the presence of the APOE e4 allele.
The symptoms of AD vary depending on the stage of the disease, which can be classified into different stages based on the level of cognitive impairment and disability experienced by individuals. The initial and most common presenting symptom of typical AD is episodic short-term memory loss, followed by problem-solving, judgement, executive functioning, and organisational skills impairments. As the disease progresses, individuals may experience language disorder, impaired visuospatial skills, neuropsychiatric symptoms like apathy, social withdrawal, disinhibition, agitation, psychosis, and wandering. In the advanced stages, patients may become mute and unresponsive to verbal requests, leading to increased dependence on caregivers.
The diagnosis of AD remains challenging, as no definitive laboratory or imaging tests are available for confirmation. However, significant progress has been made in developing neuroimaging and biochemical markers for diagnosing preclinical and early clinical stages of AD. These biomarkers include neuroimaging markers obtained through amyloid and tau PET scans, and cerebrospinal fluid (CSF) and plasma markers, such as amyloid, tau, and phospho-tau levels.
There is currently no cure for AD, and the drugs used to treat it provide only modest benefits. The two categories of drugs approved for treating AD are cholinesterase inhibitors and partial N-methyl D-aspartate (NMDA) antagonists. While the impact of AD is not limited to the individual affected, it also significantly affects the family, as patients may exhibit wandering behaviour, falls, behavioural issues, and memory loss.
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Alzheimer's disease and stroke often coexist
Alzheimer's disease (AD) and stroke are age-related disorders that often coexist, with stroke being a known risk factor for the development of AD. However, the reverse association, i.e., whether AD increases the chances of developing a stroke, has not been studied extensively.
Pathophysiological Links
Stroke is a cerebrovascular disorder that occurs due to blocked blood flow in the brain, resulting in the formation of a clot and, subsequently, neurodegeneration and cell death. On the other hand, AD is a neurodegenerative disorder characterised by the accumulation of amyloid-β plaques and neurofibrillary tangles, leading to cognitive impairment and functional decline.
The pathophysiology of AD and stroke share some common mechanisms. For instance, AD is commonly associated with cerebral amyloid angiopathy (CAA), which significantly increases the risk of hemorrhagic stroke. Additionally, patients with AD exhibit greater cognitive impairment, and multiple pathophysiological mechanisms are shared between the two disorders.
Risk Factors
The risk factors for AD include both modifiable and non-modifiable factors. Modifiable risk factors include smoking, lack of education, head trauma, vascular disorders, heart disorders, infections, and inflammation. In contrast, non-modifiable risk factors include age, gender, family history, and genetic makeup.
Similarly, risk factors for stroke include both modifiable and non-modifiable factors. Non-modifiable risk factors include age, gender, race, and a history of transient ischemic attacks. Modifiable risk factors, such as diet, physical activity, smoking, alcohol consumption, drug abuse, diabetes, hypertension, and heart disease, play a role in the majority of stroke cases.
Prevention and Management
The management of AD focuses on modifying lifestyle factors and pharmacological interventions using acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists. In addition, disease-modifying drug therapies targeting tau pathology, the Aβ pathway, and chaperone proteins are used in advanced cases.
For stroke prevention and management, it is essential to address modifiable risk factors and treat vascular risk factors, particularly during midlife, to reduce the risk of cognitive decline associated with AD. Therapeutic interventions may also target common pathophysiological genes and mechanisms shared between AD and stroke.
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The risk of hemorrhagic stroke is higher in patients with Alzheimer's disease compared to non-Alzheimer's controls with similar risk profiles
The Risk of Hemorrhagic Stroke is Higher in Patients with Alzheimer's Disease
Alzheimer's disease (AD) and stroke are two of the most prevalent neurological disorders, and their coexistence poses significant challenges for clinical management and patient care. This review aims to explore the relationship between AD and hemorrhagic stroke, focusing on the higher risk associated with AD patients compared to non-AD controls with similar risk profiles.
Alzheimer's Disease and Stroke: An Overview
AD is a neurodegenerative disease characterized by memory loss, cognitive impairments, and progressive degeneration of behavioral and functional capacities. On the other hand, stroke is a brain disease resulting from interrupted blood supply to the brain, leading to oxygen deprivation and potential neuronal damage. Both conditions share common risk factors, including age, hypertension, diabetes, and atherosclerosis.
Higher Risk of Hemorrhagic Stroke in AD Patients
Several studies have investigated the link between AD and stroke, particularly the risk of hemorrhagic stroke in AD patients compared to non-AD controls with similar risk profiles. A meta-analysis by Waziry et al. analyzed data from eight studies and 121,719 individuals (73,044 AD and 48,675 non-AD). The results revealed that AD patients had a higher incidence rate of hemorrhagic stroke (3.41/1000 person-years) compared to non-AD controls (2.23/1000 person-years). This difference in incidence rates translated into a relative risk of 1.42 for hemorrhagic stroke in AD patients, indicating a significantly higher risk compared to non-AD controls.
Potential Mechanisms and Risk Factors
The increased risk of hemorrhagic stroke in AD patients may be attributed to various factors and mechanisms. One key factor is the association between AD and cerebral amyloid angiopathy (CAA), which involves changes in endothelial proteins and a reduced ability of the blood-brain barrier to compensate for leaks. Microbleeds identified on MRI scans are also more prevalent in AD patients and are established risk factors for hemorrhagic stroke. Additionally, the presence of the APOE e4 allele, linked to late-onset AD, may accelerate the process leading to CAA-related hemorrhagic stroke. Other risk factors, such as aspirin use in AD patients, have also been associated with an increased risk of intracerebral hemorrhage.
In summary, patients with Alzheimer's disease have a higher risk of hemorrhagic stroke compared to non-AD controls with similar risk profiles. This heightened risk underscores the importance of considering cerebrovascular complications in the management of AD and highlights the need for further research to optimize interventions and improve the prognosis and quality of life for this vulnerable population.
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Frequently asked questions
Strokes are a risk factor for Alzheimer's disease. Vascular dysfunction is increasingly recognised in the pathophysiology of Alzheimer's disease, and studies have shown that patients with Alzheimer's have a higher risk of experiencing a stroke. However, the pathophysiological relationship between the neurodegenerative processes in Alzheimer's and vascular dysfunction is complex.
A stroke is a disease of the blood vessels in and around the brain. It occurs when the brain does not receive enough blood to function normally, or when a blood vessel ruptures.
The symptoms of a stroke vary depending on which part of the brain is affected. Common symptoms include paralysis or loss of sensation in part of the body, slurred speech, loss of vision or double vision, loss of balance, and loss of bladder and bowel control.
Alzheimer's disease is the most prevalent neurodegenerative disease leading to dementia. It is characterised by memory loss, multiple cognitive impairments, and progressive degeneration of behavioural and functional capacities.
Vascular dementia is the second most common form of dementia after Alzheimer's disease. It is caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients.
Stroke is the major factor for vascular dementia. Research has shown that patients who have had a stroke have a far greater risk of developing vascular dementia than those who have not.