Authors: Purandare, N.¹; Oude Voshaar, R. C.²; Burns, A.¹; Velupandian, U. M.³; McCollum, C.³

Source: Neurological Research, Volume 28, Number 6, September 2006 , pp. 679-684(6)

Publisher: Maney Publishing

Abstract:

Background: There are considerable overlaps between vascular dementia and Alzheimer's disease (AD), with a suggestion that cerebrovascular disease (CVD) contributes to the neurodegenerative pathology of AD. Paradoxical embolization of venous emboli into the systemic circulation through a venous to arterial circulation shunt (v-aCS), the most commonly a patent foramen ovale (PFO), is known to cause cryptogenic stroke in younger people. We reviewed the potential role of paradoxical embolization in AD.

Methods: A review of the literature on paradoxical embolization in neurological disorders and techniques to detect v-aCS and PFO, supplemented by data from our own studies.

Results: Before our research, the role of paradoxical embolism in dementia had not been studied. The potential role of embolization in cerebral damage was highlighted by studies in patients undergoing coronary artery bypass or carotid surgery. Paradoxical embolization was found to occur in patients with cryptogenic stroke, migraine, decompression sickles and during hip surgery. The methods for detecting v-aCS or PFO had not been standardized. We found 'significant' v-aCS (equivalent to PFO) in 32% of AD patients compared with 22% of controls, but the study was not sufficiently powered to test the statistic significance of this difference. In AD, there was evidence of an association between 'significant' v-aCS and the severity of white matter hyperintensities on magnetic resonance imaging (MRI).

Conclusion: Paradoxical embolization through a v-aCS may be a potentially preventable or treatable cause of CVD in AD.

Keywords: ALZHEIMER'S DISEASE; CEREBROVASCULAR DISEASE; RIGHT-TO-LEFT SHUNT; PATENT FORAMEN OVALE; PARADOXICAL EMBOLI

Document Type: Research Article

DOI: http://dx.doi.org/10.1179/016164106X130425

Affiliations: 1: Division of Psychiatry, Education and Research Center, Wythenshawe Hospital, University of Manchester, Wythenshawe, Manchester, M23 9LT, UK 2: Division of Psychiatry, Education and Research Center, Wythenshawe Hospital, University of Manchester, Wythenshawe, Manchester, M23 9LT, UK; Department of Psychiatry, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands 3: Vascular Studies Unit and Academic Surgery Unit, South Manchester University Hospital, University of Manchester, Wythenshawe, Manchester, M23 9LT, UK

Publication date: 2006-09-01

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