The contribution of vascular risk factors in neurodegenerative disorders: from mild cognitive impairment to Alzheimer’s disease

• Published in: Alzheimer's research & therapy Vol. 12; no. 1; pp. 1 - 10
• Main Authors: Cheng, Yu-Wen, Chiu, Ming-Jang, Chen, Ya-Fang, Cheng, Ting-Wen, Lai, Ya-Mei, Chen, Ta-Fu
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 04.08.2020; BioMed Central; BMC
• Subjects: Alzheimer's disease; Alzheimer’s disease (AD); Apolipoproteins; Biomarkers; Blood cholesterol; Blood pressure; Cholesterol; Cognitive ability; Dementia; Diabetes; Hypertension; Low density lipoproteins; Low-density lipoprotein (LDL) cholesterol; Magnetic resonance imaging; Medical imaging; Medical records; Medical research; Metabolic disorders; Mild cognitive impairment (MCI); Neurodegeneration; Older people; Pathology; Plasma; Plasma biomarkers; Regression analysis; Risk factors; Statins; Vascular risk factors
• ISSN: 1758-9193; 1758-9193
• DOI: 10.1186/s13195-020-00658-7

Background Optimization of vascular risk factor control is emerging as an alternative approach to improve cognitive outcomes in Alzheimer's disease, although its efficacy is still under debate. We aimed to investigate the contribution of vascular risk factors on Alzheimer's biomarkers and conversion rate to dementia in subjects with mild cognitive impairment (MCI) with low cerebral small vessel disease burden. Methods Two hundred ninety-five newly diagnosed MCI subjects were enrolled from March 2005 to May 2017 for a cross-sectional assessment of vascular risk factors and Alzheimer's plasma and imaging biomarkers, followed by a cognitive outcome assessment 24 months after enrollment. The association between vascular risk factors and Alzheimer's biomarkers were tested using multivariable linear regression models adjusted with age, gender, education, and APOE [epsilon]4 allele. The association between vascular risk factors and conversion to dementia was tested using multivariable logistic regression models adjusted with age, gender, education, and baseline Mini-Mental State Examination (MMSE) score. Results At baseline, higher low-density lipoprotein (LDL) cholesterol level was associated with more advanced plasma biomarkers, including A[beta]42/A[beta]40 ratio (P = 0.012) and tau level (P = 0.001). A history of hypertension was associated with more advanced white matter hyperintensity (P = 0.011), while statin therapy for dyslipidemia was associated with less advanced white matter hyperintensity (P = 0.002). At 24 months, individual vascular risk factor was not significantly associated with cognitive outcome. By contrast, statin therapy for dyslipidemia was associated with reduced conversion to dementia (adjusted OR = 0.191, 95% CI = 0.062~0.586, P = 0.004). Conclusions For MCI subjects, dyslipidemia may contribute to AD-related neurodegeneration while hypertension may contribute to vascular pathology. The association between statin therapy for dyslipidemia and reduced conversion to dementia supports further interventional study to evaluate the potential beneficial effect of statin in MCI subjects. Keywords: Alzheimer's disease (AD), Low-density lipoprotein (LDL) cholesterol, Mild cognitive impairment (MCI), Plasma biomarkers, Vascular risk factors