2. Association between cognitive impairment and cerebrovascular disease
Hege Ihle-Hansen
MD, phd
Vestre Viken HT, Bærum Hospital
Norway

3. Outline Introduction Challenges Future directions Cognition
Cerebrovascular disease
Challenges
Link between vascular disease and cognition
Impact of vascular risk factors and treatment of vascular disease in older age
Pathophysiology
Future directions

4. What do we need to know
Cardio vascular disease (CVD) and dementia shear many risk factors
Many risk factors are modifiable
Early identification and risk control may preserve cognitive function

5. Introduction

6. Neurocognitive disorders DSM-5
Ability to think
Clinical diagnosis
Contiuum
Normal
Mild neurocognitive disorder
Major neuricognitive disorder
Different subtypes or causes

7. Cerebrovascular disease

8. Atherosclerosis and cognition

9. Link between vascular disease and cognition
Challenges
Link between vascular disease and cognition

10. Dementia after stroke
10% av pasienter innlagt med første hjerneslag har demens før hjerneslag. 10% vil få demens som følge av hjerneslaget. Av alle innlagte slagpasienter vil ca 25% ha demens 1 år etter hjerneslaget. Høyest andel ved tilbakevendende hjerneslag.
Videre ser man en gradvis økende prosentandel som utvikler demens.
Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI)
Pendlebury, Int J Stroke, 2012

11. Cerebral White Matter Lesions and the Risk of Dementia
Severity of white matter lesions (WML) is divided into 3 categories based on the distribution of periventricular WML scores. The risk of dementia is expressed as age- and sex-adjusted hazard ratios. The number of dementia cases and total number of participants, respectively, in consecutive periventricular WML severity categories were 16 and 749 (grade 0-3), 18 and 261 (grade >3-6), 11 and 66 (grade >6-9), and in consecutive subcortical WML severity categories 24 and 763 (0-1 mL), 10 and 244 (>1-6 mL), and 10 and 65 (> mL).
Arch Neurol. 2004;61(10):

12. Kivipelto, Lancet Neurol 2006

13. Challenges
Impact of vascular risk factors and treatment of vascular disease in older age

14. Risk factors for stroke
High blood pressure 
Cigarette smoking 
Diabetes mellitus 
Carotid or other artery disease 
Atrial fibrillation 
Other heart disease 
High blood cholesterol 
Poor diet 
Physical inactivity and obesity 
Stress

15. Source: Misfinancing global health: a case for transparency in disbursements and decision making. The Lancet D Sridhar, R Batniji 27 September 2008, 372: 9644,

18. Is it of clinical importance?
Barnes, Lancet Neurol 2011

19. Challenges
Pathophysiology

20. Vascular risk
Vascular risk factors leads to angiopahty leading to cognitive decline
macrovascular
micro vascular
Induce inflammation
Interact with AD
The vascular risk can directly increase the suscetibility to Alzheimer’s disease

21. Possible interactions between vascular and degenerative disease
Loss of neurons
Morbus Alzheimers
Amyloid-β
Cerebrovascular disease
Ischemia
Dementia
↑secretase activity
↓Aβ clearance
Vascular Aβ deposit
↑tau phosphorylation
Vasoconstriction

22. We aimed to explore the association between
total-tau and brain atrophy,
measured as ventricular volume and total brain volume,
one year post-stroke

24. Future directions

25. Acute stroke treatment

26. Different trajectories
Pet – amyloid avleiring 10 år før symptomer på kognitiv svikt
Kartelgge alle slagpasienter med spinalpunkjson eller PET ?
Inflammasjonen – vaskulære risikofakorer ? Gener?
Mulige behmål – antiinflammatoriske legemidler ?
Thiel et al Stroke. 2014;45:

27. The Seven ways of life
Be smart, exercise your heart: exercise effects on brain and cognition

28. Global targets for NCDs
To be attained by 2025

30. Association between cognitive impairment and cerebrovascular disease
Researsch
Early diagnosis
Prediction
Prevention
Treatment
Risk factors
Physical and cognitive training
Succussfull aging?
Expectations
Multifactorial risk