Cerebrovascular disease (CVD) is
the most common life-threatening neurological event in the United States,
killing about 140,000 American’s each year. This equates to about every 1 out
of every 20 deaths (CDC, 2017). In the early 2000s, an estimated 157,803 deaths
were CVD related, and 138,397 of these deaths occurred to individuals 65 and
older. Per 100,000 males ages 65+, CVD causes 890 deaths, which has a rate of
102.7, accounting for 4.5% of overall deaths for these individuals. Per 100,000
females ages 65+, CVD accounts for 725 deaths, which has a rate of 74.2, and
accounts for 4.9% of deaths for individuals of this age (DSHS, 2017).
disease happens when there is a stoppage of blood going towards or inside the
brain. CVD includes all disorders where brain is temporarily or permanently affected
by ischemia or bleeding. People experiencing symptoms of CVD complain of: vomiting and
nausea, memory loss or confusion, numbness and tingling in the arm, leg, or
face, slurred speech, vision problems and difficulty or inability to walk. The
most common types of CVD include ischemic stroke, where carotid arteries become
blocked with a fatty buildup, called plaque; and hemorrhagic stroke, where an
artery in or on the surface of the brain has ruptured or leaks, causing
bleeding and damage in or around the brain (American Heart Association, 2017).
I chose this population of Americans because
by this age, most will have had CVD and will be at a greater risk of being
diagnosed with other diseases. Past family medical records, gender, age all
effect the possibility of having a stroke. In this paper, I will be discussing
the current research on how cerebrovascular disease influences the chance of
risk of individuals aged 65 and older to be diagnosed with Alzheimer’s Disease
(AD), Parkinson’s Disease (PD) and overall dementia.
of Cerebrovascular Disease and Alzheimer’s Disease
disease and Alzheimer’s disease frequently occur at the same time, which leads this
to being the leading cause of age-related cognitive impairment. 1 in 10
individuals ages 65+ have Alzheimer’s (alz.org, 2017). Alzheimer’s disease is a
neurodegenerative disorder that’s associated with large-scale brain
functionality and structural network dysfunctions. Adding cerebrovascular
disease can increase the decline in the executive function, causing a reduction
in the frontal lobe metabolism rates, which leads to an increase in the
disrupted functionality of the connection in the fronto-parietal region of the
brain (alz.org, 2017). Both of these diseases are proposed to have additive
effects on cognitive decline.
Chong, J., Liu, S., Loke, Y., Hilal, S.,
Ikram M., Xu, X., Tan, B., Venketasubramanian, N., Chen, C., and Zhou, J (2017),
study both the intrinsic functional connectivity and structural covariance
approaches in comparing large-scale brain network changes to Alzheimer’s
patients with and without CVD. This study also focused on two higher order
cognitive networks: Default Mode Network (DMN) and Executive Control Network
(ECN), which leads to the prediction that Alzheimer’s disease patients with and
without CVD would feature divergent connectivity changes across these two cognitive
This study used participants from 5 various
groups: Alzheimer’s disease with cerebrovascular disease (AD + CVD),
Alzheimer’s disease without cerebrovascular disease (AD), cognitive impairment
no dementia (CIND) with cerebrovascular disease (CIND + CVD), cognitive
impairment no dementia without cerebrovascular disease (CIND), and healthy
controls. Each group used the same
number of participants (n=47) which totaled 235 patients. (Chong et al, 2017).
of this study suggest that both CVD and non-CVD groups exhibit divergent
functional connectivity and structural covariance changes in the DMN and ECN.
This implies that different pathologies
may underline the two groups. These results support the hypothesis that the
effects of AD and CVD are additive (Chong et al, 2017).
Limitations to this study included the
participants were not age or educationally matched, but these effects were
controlled for in the analysis. This study was of cross-sectional design, not a
longitudinal study that would ensure a better way to track individual changes
in functional connectivity and the structural covariance networks as disease
progresses. Thirdly, the results were a seed-based approach that allows the
results to be interpreted as changes in the connectivity levels from the seed
region as opposed to whole-network connectivity levels that were derived from
independent component analysis.
In conclusion, this study found that CVD
groups have more CVD specific symptoms with less AD related network changes
than NCVD groups with the same level of dementia severity. Ideally, further
research in this topic should look into the combination of structural and
functional network imaging which may increase the knowledge on the differential
network phenotypes between CVD and NCVD groups.
of Cerebrovascular Disease and Parkinson’s Disease
is a progressive, neurodegenerative disorder that predominately affects
dopamine-producing neurons in the substantia nigra region of the brain (parkinson.org,
2017). This can cause an individual
to have symptoms such as tremors, bradykinesia, rigidity of the limbs, and
gait/balance problems. Parkinson’s is more common in males than in females.
Zambito S., Gioulis, M., Pistacchi, M., &
Lo Cascio, C. (2016) study evaluated the neurosonological assessment of a group
of PD patients that matched with a control group comprised of normal
participants in order to evaluate the potential risk of developing CVD in the
group with PD. Thirty participants ages
70-80 were matched with a control group comprised of 30 participants as well.
Both patients and caregivers of each group were questioned about the
occurrences of fluctuations and dyskinesias at the time of the initial
interview, plus their medical history. Subjects were then selected so the demographic
characteristics between the groups was comparable. Every patient underwent
various examinations to test the intima-media thickness (IMT) for both the
right and left common carotid arteries.
Data from this study supports the hypothesis
that the dopamine deficiency in the group of PD patients might provide
additional protection against CVD. By lowering the IMT values in the PD group
than the control group found a significant correlation between the IMT values
in the left side and the dopamine intake suggested that there could be a
reduction of the risk level of developing CVD in PD patients (Zambito et al,
of Cerebrovascular Disease for Diabetes Mellitus and Overall Dementia
Dementia is a progressive brain
dysfunction that affects more than 6% of individuals aged 65 and over. The prevalence
of this disease increases to more than 20% for individuals who are over the age
of 85. 12% of individuals aged 65-70 suffer from diabetes mellitus. Diabetes Mellitus
(DM) is a chronic illness that is characterized by defects of a body’s ability
to use or produce insulin (CDC, 2017).
The purpose of the study
by Lu, Z. K., Li, M., Yuan,
J., & Wu, J (2016) examines the role of
CVD, and how it affects diabetes on two specific types of dementia: Alzheimer’s
or vascular dementia. Lu et al (2016) hypothesize that there’s (1) a positive
association between DM and overall dementia; (2) a positive association between
DM and vascular dementia; (3) an association between DM and AD; and (4) that these associations are
partially mediated through cerebrovascular disease. Their study suggests
that there is not a significant association between DM, AD and vascular
A strength of this
study found a direct, positive association between DM and overall dementia.
Secondly, it is the first study to quantitatively evaluate the role of
cerebrovascular disease. This study found CVD only partially mediates the
association, and that there’s a direct positive association between DM and vascular
dementia. Although, this study failed to find associations between DM, dementia
and AD after controlling for CVD. Overall, the findings are consistent with
previous studies, which used different ways of identifying vascular dementia
and Alzheimer’s disease.
Limitations of this
cross-sectional study include not having sequential information on the diagnosis
of dementia and diabetes, therefore, a causal relationship is not confirmed. To
decrease limitations, a longitudinal dataset with different ways of identifying
the outcome variables would be preferred. Overall, this suggests that DM is
associated independently with overall dementia among the elderly, but not with AD
and vascular dementia.
Conclusion and Future
CVD is a degenerative disease, research has found a negative chance of developing
Parkinson’s disease with CVD. The AANS found that about 25% of individuals who
recover from their first stroke will have another stroke within five years. CVD
can happen before the age of 65, realizing the possibility of other life-threatening
diseases that can be added is an area for future research. Since the population
of 65+ year olds will be growing from generations to follow, another area of
future research is that of cures and easier preventative measures other than
anti-clotting drugs for every member of every socioeconomic status to be easily
and readily accessible. Overall, studies support that CVD influences the positive
chance of an individual acquiring diabetes mellitus/dementia, along with the
chance of suffering from AD.