Cerebrovascular disease (CVD) isthe most common life-threatening neurological event in the United States,killing about 140,000 American’s each year. This equates to about every 1 outof every 20 deaths (CDC, 2017). In the early 2000s, an estimated 157,803 deathswere CVD related, and 138,397 of these deaths occurred to individuals 65 andolder. Per 100,000 males ages 65+, CVD causes 890 deaths, which has a rate of102.
7, accounting for 4.5% of overall deaths for these individuals. Per 100,000females ages 65+, CVD accounts for 725 deaths, which has a rate of 74.2, andaccounts for 4.9% of deaths for individuals of this age (DSHS, 2017). Thisdisease happens when there is a stoppage of blood going towards or inside thebrain.
CVD includes all disorders where brain is temporarily or permanently affectedby ischemia or bleeding. People experiencing symptoms of CVD complain of: vomiting andnausea, memory loss or confusion, numbness and tingling in the arm, leg, orface, slurred speech, vision problems and difficulty or inability to walk. Themost common types of CVD include ischemic stroke, where carotid arteries becomeblocked with a fatty buildup, called plaque; and hemorrhagic stroke, where anartery in or on the surface of the brain has ruptured or leaks, causingbleeding and damage in or around the brain (American Heart Association, 2017). I chose this population of Americans becauseby this age, most will have had CVD and will be at a greater risk of beingdiagnosed with other diseases.
Past family medical records, gender, age alleffect the possibility of having a stroke. In this paper, I will be discussingthe current research on how cerebrovascular disease influences the chance ofrisk of individuals aged 65 and older to be diagnosed with Alzheimer’s Disease(AD), Parkinson’s Disease (PD) and overall dementia. Influenceof Cerebrovascular Disease and Alzheimer’s Disease Cerebrovasculardisease and Alzheimer’s disease frequently occur at the same time, which leads thisto being the leading cause of age-related cognitive impairment. 1 in 10individuals ages 65+ have Alzheimer’s (alz.org, 2017).
Alzheimer’s disease is aneurodegenerative disorder that’s associated with large-scale brainfunctionality and structural network dysfunctions. Adding cerebrovasculardisease can increase the decline in the executive function, causing a reductionin the frontal lobe metabolism rates, which leads to an increase in thedisrupted functionality of the connection in the fronto-parietal region of thebrain (alz.org, 2017). Both of these diseases are proposed to have additiveeffects 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 covarianceapproaches in comparing large-scale brain network changes to Alzheimer’spatients with and without CVD. This study also focused on two higher ordercognitive networks: Default Mode Network (DMN) and Executive Control Network(ECN), which leads to the prediction that Alzheimer’s disease patients with andwithout CVD would feature divergent connectivity changes across these two cognitivenetworks. This study used participants from 5 variousgroups: Alzheimer’s disease with cerebrovascular disease (AD + CVD),Alzheimer’s disease without cerebrovascular disease (AD), cognitive impairmentno dementia (CIND) with cerebrovascular disease (CIND + CVD), cognitiveimpairment no dementia without cerebrovascular disease (CIND), and healthycontrols. Each group used the samenumber of participants (n=47) which totaled 235 patients.
(Chong et al, 2017). Resultsof this study suggest that both CVD and non-CVD groups exhibit divergentfunctional connectivity and structural covariance changes in the DMN and ECN.This implies that different pathologiesmay underline the two groups. These results support the hypothesis that theeffects of AD and CVD are additive (Chong et al, 2017).
Limitations to this study included theparticipants were not age or educationally matched, but these effects werecontrolled for in the analysis. This study was of cross-sectional design, not alongitudinal study that would ensure a better way to track individual changesin functional connectivity and the structural covariance networks as diseaseprogresses. Thirdly, the results were a seed-based approach that allows theresults to be interpreted as changes in the connectivity levels from the seedregion as opposed to whole-network connectivity levels that were derived fromindependent component analysis. In conclusion, this study found that CVDgroups have more CVD specific symptoms with less AD related network changesthan NCVD groups with the same level of dementia severity. Ideally, furtherresearch in this topic should look into the combination of structural andfunctional network imaging which may increase the knowledge on the differentialnetwork phenotypes between CVD and NCVD groups. Influenceof Cerebrovascular Disease and Parkinson’s Disease Parkinson’s,is a progressive, neurodegenerative disorder that predominately affectsdopamine-producing neurons in the substantia nigra region of the brain (parkinson.org,2017). This can cause an individualto have symptoms such as tremors, bradykinesia, rigidity of the limbs, andgait/balance problems.
Parkinson’s is more common in males than in females. Zambito S., Gioulis, M., Pistacchi, M., Cascio, C. (2016) study evaluated the neurosonological assessment of a groupof PD patients that matched with a control group comprised of normalparticipants in order to evaluate the potential risk of developing CVD in thegroup with PD. Thirty participants ages70-80 were matched with a control group comprised of 30 participants as well.Both patients and caregivers of each group were questioned about theoccurrences of fluctuations and dyskinesias at the time of the initialinterview, plus their medical history.
Subjects were then selected so the demographiccharacteristics between the groups was comparable. Every patient underwentvarious examinations to test the intima-media thickness (IMT) for both theright and left common carotid arteries. Data from this study supports the hypothesisthat the dopamine deficiency in the group of PD patients might provideadditional protection against CVD. By lowering the IMT values in the PD groupthan the control group found a significant correlation between the IMT valuesin the left side and the dopamine intake suggested that there could be areduction of the risk level of developing CVD in PD patients (Zambito et al,2016).Influenceof Cerebrovascular Disease for Diabetes Mellitus and Overall Dementia Dementia is a progressive braindysfunction that affects more than 6% of individuals aged 65 and over. The prevalenceof this disease increases to more than 20% for individuals who are over the ageof 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 abilityto use or produce insulin (CDC, 2017).
The purpose of the studyby Lu, Z. K., Li, M., Yuan,J., & Wu, J (2016) examines the role ofCVD, and how it affects diabetes on two specific types of dementia: Alzheimer’sor vascular dementia. Lu et al (2016) hypothesize that there’s (1) a positiveassociation between DM and overall dementia; (2) a positive association betweenDM and vascular dementia; (3) an association between DM and AD; and (4) that these associations arepartially mediated through cerebrovascular disease.
Their study suggeststhat there is not a significant association between DM, AD and vasculardementia. A strength of thisstudy found a direct, positive association between DM and overall dementia.Secondly, it is the first study to quantitatively evaluate the role ofcerebrovascular disease. This study found CVD only partially mediates theassociation, and that there’s a direct positive association between DM and vasculardementia. Although, this study failed to find associations between DM, dementiaand AD after controlling for CVD. Overall, the findings are consistent withprevious studies, which used different ways of identifying vascular dementiaand Alzheimer’s disease.
Limitations of thiscross-sectional study include not having sequential information on the diagnosisof dementia and diabetes, therefore, a causal relationship is not confirmed. Todecrease limitations, a longitudinal dataset with different ways of identifyingthe outcome variables would be preferred. Overall, this suggests that DM isassociated independently with overall dementia among the elderly, but not with ADand vascular dementia.
Conclusion and FutureResearchAlthoughCVD is a degenerative disease, research has found a negative chance of developingParkinson’s disease with CVD. The AANS found that about 25% of individuals whorecover from their first stroke will have another stroke within five years. CVDcan happen before the age of 65, realizing the possibility of other life-threateningdiseases that can be added is an area for future research. Since the populationof 65+ year olds will be growing from generations to follow, another area offuture research is that of cures and easier preventative measures other thananti-clotting drugs for every member of every socioeconomic status to be easilyand readily accessible. Overall, studies support that CVD influences the positivechance of an individual acquiring diabetes mellitus/dementia, along with thechance of suffering from AD.