The influence of coincidental vascular pathology on symptomatology and course of Alzheimer's disease

The aim of this review is to determine the influence of coincidental cerebr ovascular pathology on the symptomatology and course of Alzheimer's disease (AD). The link between stroke and AD is probably higher than expected by c hance for the following reasons: (i) both pathologies share genetic risk fa ctors such as the epsilon 4 allele of the apolipoprotein E gene; (ii) AD pa tients have changes in the brain vessels that may lead to either ischemic o r hemorrhagic stroke or white matter changes or both; (iii) there is eviden ce of an increased risk of stroke in AD patients; (iv) there is evidence of a frequent association of AD and stroke at autopsy. Because of the summati on of the various types of lesions, stroke lesions may lead to an increase progression of cognitive decline in AD patients. Recognition of a vascular component in a dementia syndrome is therefore useful for the management of AD patients. Whether an optimal management of risk factors for stroke may d elay the clinical expression of dementia in patients with preclinical Alzhe imer pathology should be evaluated.