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Examination of Vascular Comorbidity and Alzheimer’s Progression Pathways

February 22, 2022Neelem Sheikh

Modifiable risk factors for Alzheimer’s disease, including diabetes, midlife hypertension, midlife obesity, smoking, physical inactivity, depression, and low educational attainment, contribute to up to half of Alzheimer’s cases globally (17.2 million) and in the U.S. (2.9 million). Researchers projected that if even a 10% to 25% reduction in all seven risk factors were to take place, it could potentially prevent as many as 1.1 to 3 million cases worldwide and 184,000 to 492,000 cases in the U.S.

It has long been known that vascular conditions, such as stroke and heart disease, as well as vascular risk factors, such as hypertension, hypercholesterolemia, type 2 diabetes, and obesity, may increase the risk of developing Alzheimer’s disease. However, more recent research suggests that in addition to contributing to the development of Alzheimer’s disease, some vascular risk factors may also contribute to the rate of progression of Alzheimer’s disease.

Understanding how comorbidities uniquely affect Alzheimer’s patients and their respective progression pathways at a hyper-personalized level is fundamental to informing precision medicine approaches to enable the most effective and personalized treatment and care possible.

Below, we provide a more detailed evaluation of vascular comorbidity and Alzheimer’s progression as well as steps toward precision medicine approaches in brain health.

Vascular Comorbidity and Alzheimer’s Progression

Over the years, there have been several studies assessing the impact of vascular risk factors on Alzheimer’s progression, with some suggesting that hypertension, hypercholesterolemia, and diabetes are associated with a greater rate of cognitive decline, while others did not show a significant influence of vascular risk factors on Alzheimer’s progression. Some studies even showed that diabetes was associated with a slower rate of neurocognitive decline in Alzheimer’s patients. It’s clear there is a link between vascular comorbidity and Alzheimer’s progression, but it’s unclear which particular vascular risk factor(s) are the primary factor(s) driving decline in neurocognitive function.

A 2011 study aimed to address this very question, assessing vascular risk factors, including hypertension, hypercholesterolemia, and diabetes, and their influence on the progression of Alzheimer’s disease. In addition to confirming the findings of previous studies regarding the influence of age at onset, education level, and occupational attainment, they found a strong correlation between hypertension and Alzheimer’s progression.

While there were no significant associations between diabetes or hypercholesterolemia and annual Mini-Mental State Exam (MMSE) scores, a multiple regression analysis revealed that hypertension was a significant variable associated with annual MMSE scores—more specifically, younger, more educated individuals with hypertension had a greater decline in annual MMSE scores. This suggests that hypertension may be a primary risk factor in driving decline in neurocognitive function.

Longitudinal Monitoring to Inform Precision Medicine Approaches

It is important to understand these associations between vascular comorbidity and Alzheimer’s progression, as understanding the unique manifestation of neurocognitive impairments, as well as the unique rates of progression in each Alzheimer’s patient, are fundamental to providing the most effective, precise, and personalized treatment and care for each patient.

As alluded to above, we are seeing a definite shift towards the incorporation of precision medicine approaches in neurology. To adequately inform precision medicine approaches in brain health as a whole, there is a need for sensitive longitudinal monitoring tools that can produce hyper-personalized, highly granular measures of neurocognitive function in high frequency.

Altoida’s mission is to accelerate and improve drug development, neurological disease research, and patient care. To learn more about our precision-neurology platform and app-based medical device, contact us!

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