Transcranial and extracranial ultrasound assessment of cerebral hemodynamics in vascular and Alzheimer's dementia

Background: Increasing life expectancy of the population leads to a higher incidence of dementia. Exact differentiation between the most common types, vascular dementia ( VD) and Alzheimer's dementia ( AD), is crucial to the development and application of new treatment strategies. Both conditions are thought to differ greatly by their extent of microvascular affection. Transcranial and extracranial ultrasound permits analysis of cerebral hemodynamics and should help to differentiate between VD and AD. We compare multimodal ultrasound data between VD, AD and controls, and give an overview of the literature on this topic. Methods: Twenty VD and 20 AD patients were studied and compared with 12 age-matched controls. Transcranial color-coded ultrasound was performed to assess blood flow velocity ( Vmean) and pulsatility indices ( PI) of the middle cerebral artery (MCA). Extracranial duplex and Doppler ultrasound techniques were used to assess the blood volume flow (BVF) in the anterior circulation ( both internal carotid arteries [ICA]) and posterior circulation ( both vertebral arteries [VA]), the global cerebral blood flow (CBF = BVFICA + BVFVA), the global cerebral circulation time (CCT = time delay of echo-contrast bolus arrival between ICA and internal jugular vein) and global cerebral blood volume (CBV = CCT 6 CBF). Results: MCA Vmean in VD ( 36 +/- 8 cm/ s) and AD ( 43 +/- 13 cm/ s) were significantly lower than in controls ( 59 +/- 13 cm/ s) but did not differ significantly between VD and AD groups. PI (1.1 +/- 0.2; 1 +/- 0.2; 0.9 +/- 0.2) only differed significantly between VD group and controls. CBF and CCT in VD ( 570 +/- 61 ml/ min; 8.8 +/- 2.6 s) and AD ( 578 +/- 77 ml/ min; 8.2 +/- 1.4 s) were similar but differed significantly from controls ( 733 +/- 54 ml/ min; 6.4 +/- 0.8 s). BVF in the anterior and posterior circulation of VD group ( 412 +/- 62 and 158 +/- 38 ml/ min) and AD group ( 428 +/- 62 and 150 +/- 41 ml/ min) were significantly lower than in controls ( 537 +/- 48 and 199 +/- 26 ml/ min) but did not differ significantly between the patient groups. Discussion: Transcranial and extracranial ultrasound does not help to distinguish between VD and AD. However, our results add insight into the pathophysiology of dementia, arguing in favor of a common 'vascular' pathway in both conditions.