Vascular dementia and anticardiolipin antibodies

Abstract

An association between anticardiolipin antibodies and dementia has been reported in several recent
studies; however, its physiopathological mechanism remains controversial. The aim of this study was to evaluate the association of vascular dementia and anticardiolipin antibodies. Material/Methods: A random prospective investigation of 17 male and 13 female patients with vascular dementia was made with regard to anticardiolipin antibodies. Their ages ranged from 56 to 77 years (average: 67.2 years). The criteria of NINDS-AIREN were used to defi ne the vascular dementia. A control group of 25 female and 9 male patients was formed with ages ranging from 62 to 80 years (mean: 68 years). Evaluation of the anticardiolipin antibodies was performed by means of Enzyme-Linked Immunoabsorbent Assay (ELISA) for the quantitative measurement of IgG and IgM antibodies against cardiolipins in serum. Statistical analysis was done using the Fisher’s exact test, where p<0.05 was considered signifi cant. Results: Elevated levels of anticardiolipin antibodies were detected in 56.6% of the patients with vascular dementia and 26.4% of the control group (p<0.02). Conclusions: There was a signifi cant difference in the prevalence of high levels of anticardiolipin antibodies between the group of patients with vascular dementia and the control group. This proves that anticardiolipin antibodies present a risk factor for vascular dementia.

Full text

Vascular dementia and anticardiolipin antibodies
José Maria Pereira de Godoy1ABCDEF, Maria Regina Pereira de Godoy2ABCDEF,
José Paulo Cipulo2ACD, Valdir Antonio Tognola3ACD
1 Department of Cardiology and Vascular Surgery, São José do Rio Preto University School of Medicine, São Paulo,
Brazil
2 Department of Clinics, São José do Rio Preto University School of Medicine, São Paulo, Brazil
3 Department of Neurology, São José do Rio Preto University School of Medicine, São Paulo, Brazil
Source of support: Departmental sources
Summary
Background:
An association between anticardiolipin antibodies and dementia has been reported in several re-
cent studies; however, its physiopathological mechanism remains controversial. The aim of this
study was to evaluate the association of vascular dementia and anticardiolipin antibodies.
Material/Methods:
A random prospective investigation of 17 male and 13 female patients with vascular dementia was
made with regard to anticardiolipin antibodies. Their ages ranged from 56 to 77 years (average:
67.2 years). The criteria of NINDS-AIREN were used to defi ne the vascular dementia. A control
group of 25 female and 9 male patients was formed with ages ranging from 62 to 80 years (mean:
68 years). Evaluation of the anticardiolipin antibodies was performed by means of Enzyme-Linked
Immunoabsorbent Assay (ELISA) for the quantitative measurement of IgG and IgM antibodies
against cardiolipins in serum. Statistical analysis was done using the Fisher’s exact test, where p<0.05
was considered signifi cant.
Results:
Elevated levels of anticardiolipin antibodies were detected in 56.6% of the patients with vascular
dementia and 26.4% of the control group (p<0.02).
Conclusions:
There was a signifi cant difference in the prevalence of high levels of anticardiolipin antibodies be-
tween the group of patients with vascular dementia and the control group. This proves that anti-
cardiolipin antibodies present a risk factor for vascular dementia.
key words: dementia • vascular • anticardiolipin antibodies
Full-text PDF: http://www.medscimonit.com/fulltxt.php?IDMAN=4031
Word count: 797
Tables: 2
Figures: —
References: 32
Author’s address: José Maria Pereira de Godoy, M.D, Ph.D., Rua Floriano Peixoto, 2950, São José do Rio Preto, SP, Brazil, CEP:
15010-020, e-mail: godoyjmp@riopreto.com.br
Authors’ Contribution:
A Study Design
B Data Collection
C Statistical Analysis
D Data Interpretation
E Manuscript Preparation
F Literature Search
G Funds Collection
Received: 2003.07.29
Accepted: 2004.03.16
Published: 2005.09.01
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Clinical Research
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© Med Sci Monit, 2005; 11(9): CR430-433
PMID: 16127362
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BACKGROUND
Antiphospholipid antibodies (aPL) are a heterogeneous
group of circulating autoantibodies against anionic phos-
pholipids [1–3]. The clinical symptoms of venous and ar-
terial thrombosis and recurrent miscarriages are caused by
antiphospholipid antibodies, including anticardiolipin an-
tibodies (aCL) and lupus anticoagulant (LA) [1–4]. They
present variable clinical symptoms affecting all vessels, both
great to small, veins and arteries alike, causing myocardial
infarction, superfi cial thrombophlebitis, and arterial throm-
bosis of the retina, amongst other diseases, which shows
the wide range of involvement of these antibodies [4–6].
The association of the cerebral and pre-cerebral arteries
has been frequently reported [7,8]. There are many neu-
rological manifestations, including dementia with multiple
cerebral infarcts (strokes) [9–12], progressive ischemic en-
cephalopathy [13], amaurosis fugax [14], chorea [15], tran-
sient global amnesia [16], cerebral pseudo tumor [17], ret-
inal arterial thrombosis [5] with Sneddon’s syndrome [18],
and multiple sclerosis ]19].
The association of dementia [2,3] and aCL has been report-
ed in recent investigations in patients with elevated aCL lev-
els; however, further studies are important to evaluate the
prevalence of this association and its repercussions. The ob-
jective of this study was to evaluate anticardiolipin antibod-
ies as a risk factor for vascular dementia.
MATERIAL AND METHODS
A random prospective study of 30 patients with vascular
dementia was performed to detect elevated aCL levels.
Seventeen patients were male and 13 were female, with
ages ranging from 56 to 77 years old and a mean age of 67.2
years. The patients, who were selected in the neuro-geri-
atric outpatients’ clinic, were diagnosed with vascular de-
mentia by means of their clinical history, physical and lab-
oratory examinations, neuropsychological assessment, and
neuro-imaging. The criteria of the ‘National Institute of
Neurological and Communicative Disorders and Stroke’ and
the ‘Alzheimer’s Disease and Related Disorders Association’
(NINCDS-ADRDA) [11] were used to diagnose the disease
[20]. A control group of 25 women and 9 men was formed
from a senior citizen support group with ages ranging from
62 to 80 years and a mean of 68 years, thus with similar gen-
ders and ages. Measurements of the aCL levels were made
by means of the Enzyme-Linked Immunoabsorbent Assay
(ELISA) for quantitative measurement of IgG and IgM an-
tibodies against cardiolipins in serum. IgG levels were con-
sidered normal at less than 7, borderline between 7 and 10,
and elevated at greater than 10 GPL units/ml, and IgM lev-
els were considered normal below 4, borderline between 4
and 7, and elevated greater than 7 MPL, as recommended by
the test manufacturers. Statistical analysis was done using the
Fisher’s exact test, where p<0.05 was considered signifi cant.
RESULTS
Of the 30 patients with vascular dementia, elevated levels
of aCL were detected in 17 (56.6%) (Table 1). In the con-
trol group, nine (26.4%) of the 34 individuals also had el-
evated levels of aCL (Table 2). The Fisher exact test gave a
p-value<0.02, which is considered signifi cant.
DISCUSSION
This investigation demonstrated a signifi cant association
between aCL levels and vascular dementia. However, there
are few published studies analyzing this relation. In one
study, the presence of dementia in patients with elevated
aCL levels was detected in which 13 out of 23 (56%) of the
patients presented with dementia in a group with an aver-
age age of 68 years old [21]. Another report evidenced an
association between Alzheimer’s disease and aCL levels [11].
In yet another, an association between vascular dementia
Patient IgG (GPL) IgM (MPL)
1 2.79 6.62
2 26.8 5.0
3 6.74 11.26
4 5.74 15.7
5 15.58 6.32
6 6.2 16.7
7 4.71 13.7
8 14.4 3.57
9 4.93 0.41
10 1.6 3.4
11 4.02 6.0
12 2.71 6.75
13 10.2 1.48
14 10.32 14.57
15 20.70 21.33
16 2.47 7.1
17 15.0 1.7
18 3.38 9.0
19 2.19 1.84
20 19.7 3.7
21 62.6 15.3
22 21.5 16.8
23 4.7 3.7
24 12.7 6.6
25 2.24 2.29
26 20.7 1.8
27 9.8 3.16
28 86.0 58.7
29 3.6 1.9
30 4.9 3.0
Table1. The concentrations of IgG and IgM in patients. IgG values
>10 GPL units/ml and IgM >7 MPL units/ml are considered high.
Med Sci Monit, 2005; 11(9): CR430-433 Pereira de Godoy JM et al – Vascular dementia and anticardiolipin antibodies
CR431
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and aCL was detected [22]. In a case report, a histopatho-
logical study was performed in which the patient presented
with multiple infarction factors and elevated levels of aCL. A
study in the region of the left frontal cortex was performed
in which non-infl ammatory vasculopathy was detected, asso-
ciated with endothelial hyperplasia and thrombosis of the
small arterioles [23].
Among the few publications found, an association between
dementia and aCL was demonstrated [21–23]. Thrombotic
events triggered by aCL might contribute to the multiple
cerebral thrombotic symptoms and greater aggression to
the brain [24]. Another hypothesis is that patients with aCL
have a more aggressive evolution of arteriosclerosis, as has
been reported in some publications [25–31]. In this case, it
seems to contribute to greater cerebral ischemia and cere-
bral deterioration. However, these physiopathological mech-
anisms require further investigation.
In this study, the prevalence of the aCL was high both in the
study group (56.6%) and the control group (26.4%) when
compared with a control group of donors from a blood
bank with ages of less than 60 years [32]. This suggests an
increase of the prevalence with age [32].
CONCLUSIONS
The prevalence of elevated aCL levels in this study was sig-
nifi cantly higher in patients with vascular dementia com-
pared with the control group. Thus, elevated aCL levels
constitute a risk factor for vascular dementia and its inves-
tigation is important for these patients.
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Patient IgG (GPL) IgM (MPL)
1 6.8 3.2
2 7.2 3.8
3 6.5 4.0
4 12.8 3.2
5 6.8 2.8
6 7.2 7.8
7 11.4 4.1
8 6.5 3.6
9 5.8 3.8
10 5.9 3.2
11 6.8 4.1
12 7.1 12.9
13 5.6 3.1
14 4.8 2.6
15 6.7 3.8
16 6.1 7.5
17 15.9 4.5
18 7.3 3.7
19 6.4 2.9
20 5.8 3.2
21 7.1 2.8
22 8.2 4.2
23 5.4 2.4
24 11.8 3.0
25 6.7 4.5
26 5.6 1.2
27 7.2 2.8
28 9.8 4.0
29 5.8 9.7
30 5.6 1.2
31 6.7 3.2
32 4.3 7.6
33 5.1 3.8
34 3.5 4.6
Table 2. The concentrations of IgG and IgM in the control individuals.
IgG values >10 GPL units/ml and IgM >7 MPl units/ml are
considered high.
Clinical Research Med Sci Monit, 2005; 11(9): CR430-433
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