Objective: To investigate frequency of v-aCS and cerebral emboli in Alzheimer’s disease (AD) and vascular dementia (VaD) as paradoxical embolisation through v-aCS, frequently patent foramen ovale, may be a cause of cognitive deficits in these patients.
Design: Pilot, case-control study
Materials and Methods: 41 patients with dementia (DSM-IV criteria) and 16 age and sex matched controls underwent 1 hour transcranial Doppler (TCD) monitoring of both middle cerebral arteries (MCAs) for spontaneous cranial emboli. V-aCS was detected by intravenous injection of an air/saline ultrasound contrast at rest, and its provocation by coughing and Valsalva’s manoeuever. Carotid artery disease was assessed by duplex imaging.
Results: 24(59%) had AD and 17 (41%) had VaD. Spontaneous cerebral emboli were detected in 11/40 (27.5%) patients and only 1/15 (6.5%) control (p=0.15) with emboli most frequent in VaD (41%, p=0.04). V-aCS was detected in 25/41 (61%) patients and 7/16 (44%) controls (p= 0.24).
Conclusion: Spontaneous cerebral emboli and v-aCS were frequent in dementia. A major clinical study is justified to examine the relevance of this potentially treatable cause in prevention of dementia.
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