International Stroke Conference Digest - February 20, 2008 - (Page 1)

Combination of Alzheimer’s and cerebrovascular disease has implications for stroke outcomes Recent ReseaRch is shedding light on the coexistence of cerebrovascular disease and Alzheimer’s disease, as well as the clinical implications of the conf luence of these two conditions. A symposium titled “Cognitive Implications of Mixed Cerebrovascular and Alzheimer’s Disease” beginning at 7:30 a.m. this morning in La Louisiane C will bring together four experts to review the research and discuss its implications for stroke patient care. “The symposium will reflect a new realization that Alzheimer’s disease and vascular injury to the brain often coexist,” said session co-moderator Sandra E. Black, MD, FAHA, the Brill Chair of Neurology at the University of Toronto Sunnybrook Health Sciences Centre and Medical Director of the North-East Regional Stroke Centre, Toronto. “People call it mixed dementia to refer to the fact that both components of the dementia — the brain injury caused by vascular disease and by Alzheimer’s disease — together make for suffering and cognitive-behavioral decline,” Dr. Black added. “This is something that has only been fully appreciated over the last 10 years. It’s a relatively new concept,” she said. “It comes from some very interesting work showing that Alzheimer’s disease can cause and worsen outcomes of stroke, especially in older individuals in their 70s and 80s. Similarly, stroke may be an important contributing factor in Alzheimer’s disease progression.” Community-based autopsy studies, such as those done through family-physician practices rather than referral clinics, have shown that vascular disease contributes to cognitive decline from Alzheimer’s disease. “These studies found that the most common underpinning of dementia in the elderly is actually mixed Alzheimer’s and vascular disease,” Dr. Black noted. “An influential nun’s study showed that elderly nuns who had significant Alzheimer’s pathology at autopsy were not automatically demented, but if they had coexisting stroke, even small strokes, they were much more likely to be demented. So it looks as though having the combination of stroke and Alzheimer’s disease is much more likely to make someone cognitively impaired enough to cause dependence in activities of daily function; that is, to meet criteria for dementia,” Dr. Black said. “The fact that Alzheimer’s disease often coexists in people who present with their first TIA or first stroke has implications for treatment outcomes,” she continued. “Alzheimer’s can have a major impact on how people recover from stroke and how capable they are to collaborate in rehabilitation and comply with stroke prevention treatment. Doctors and rehab teams Alzheimer’s continued on page 8 Sandra E. Black, MD, FAHA Experts to discuss latest translational research in acute intervention A teAm of four physiciAns, each of whom have one foot in the laboratory and one foot in the clinic, will meet today to discuss several concepts that are currently making the move from pre-clinical research to clinical trials. They will also discuss how that translation is made. During the symposium, titled “New (and Some Old) Targets for Acute Intervention: From Science to the Clinic,” they will examine the foundations of translational research and the pitfalls experienced in recent clinical trials. The session will meet at 4:00 p.m. in La Louisiane. M o d e r a to r G re g o r y d e l Zoppo, MD, said better lab science is needed in order to have successful clinical trials for new stroke medicines. Dr. del Zoppo is Professor of Medicine in Hematology and Adjunct Professor of Neurology at the University of Washington Harborview Medical Center. He is a member of the Progress Review Group for Stroke for the National Institutes of Health (NIH) and the National Institute of Neurological Disorders and Stroke (NINDS). “There’s still a considerable amount of excitement about bringing new concepts and agents to clinical trial for stroke patients,” Dr. del Zoppo said. “The need has not decreased among physicians and stroke patients for proper treatments; it’s continuing.” Dr. del Zoppo pointed out that many clinical trials during the last decade featuring neural protection agents have failed. “There has been a growing sense that many agents have not lived up to their clinical expectations,” he said. “It’s really important that we have better lab science and that the science reflect what’s happening in clinical patients.” Today’s session will examine new concepts that are currently moving toward the clinic and how they were nurtured from lab science to clinical concept. Physicians will get a preview of concepts not yet available to them in practice. Dr. del Zoppo said he hopes intervention continued on page 6 http://www.strokeconference.org http://www.strokeconference.org

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International Stroke Conference Digest - February 20, 2008

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