Dementia revisited "Total costs of care for people
with Dementia could top $1.1 trillion in 2050
[in the U.S. only, and in in 2018 dollars]

---Alzheimer's Association

Dr. Alois Alzheimer declared in 1906 that 'plaques' and 'tangles' are the hallmarks that cause the disease bearing his name. Well into the second century since then, despite a continuos extensive and well-supported research of these elements, Alzheimer's disease, and dementia in general, still can't be cured, prevented, or even slowed down.

By 2050 Dementia is expected to occur every 33 seconds in the U.S. alone (nearly double the rate of the presently diagnosed disease).

This inevitably prompts to question:

Should the Cause of Dementia be Revisited?

The following information appears to have significant implication to fight for conquering the dementia plague. I thought it will be of interest since it promises a breakthrough.

Ample supporting data already available from a good number of independent studies suggesting that cerebral hypo-perfusion is the possible cause for dementia (see below). However, it's incumbent on the research sphere to generate the required experimental data and to provide a direct study proof of this condition prevalence in the general population.

The proposed study sould comprise adult subjects, way younger than the elderly. Certain percentage of those may show brain-blood-flow which, usually, expected in dementia cases regardless of subject age or health condition. This percentage may, eventually, agree with the percentage of dementia cases in the general population.

Once accomplished, it will potentially prompt implementation of the simple procedure outlined below, and hence, it could prevent the onset of dementia altogether.

This procedure calls for a routine monitoring of blood-flow to the brain, similar to how blood-pressure is routinely tested. It would allow a timely clinical/pharmacological intervention to take place and correct the condition of cerebral hypo-perfusion, where it occurs.

If you are in a position to influence the undertaking of such a research project I urge you to take action and be part of the potential solution for rendering dementia history.

The following is suggested as a possible cause of dementia: reduced blood flow in the brain is known to result in elevated brain temperature (see, for example, the pasted references below). This deficiency is fairly common in the elderly in all likelihood, and often even in much younger adults. It, therefore, likely to cause an increase of the brain temperature and is liable to result in damage to brain-cells. It ought to be in particular true where the condition becomes chronic and lingers on silently for years without being directly detected; way before any symptoms of dementia manifest themselves.

Aristotle, allegedly, stated that: "the role of the blood in the brain is to COOL the brain". Ironically, he may have been right for a change. At least this time.

Regardless whether you do, or you don't accept it as a possible cause, would you consider routine monitoring of brain-blood-flow to be of any use?

Monitoring brain-blood-flow can be readily accomplished nowadays. Although, being even less invasive, it's somewhat more cumbersome of that of blood-pressure measurement. However, ultimately it bound to be just as simple as, say, taking temperature with an electronic thermometer (and not more costly at that).

Joel Tepper
Edmonton, Alberta, Canada

===== REFERENCES =====

CCSVI, Brain Cooling and Blood Flow
Posted on September 3, 2010 by uprightdoctor

"The upper cervical spine plays an important role in the venous drainage system of the brain, brain blood flow and brain COOLING ... decreased blood flow and DECREASED COOLING capacity of the brain."
(emph. added j.t.)


Cerebral Cooling During Increased Cerebral Blood Flow in the Monkey
ArticleinProceedings of The Society for Experimental Biology and Medicine 124(2):555-7
March 1967with1 Read
DOI: 10.3181/00379727-124-31788 Source: PubMed

"... Intracerebral temperature gradients are basically dependent upon the rate of REMOVAL of heat from the brain by the arterial blood."
(emph. added j.t.)


Comparison of brain temperature to core temperature
J Neurosci Nurs. 2004 Feb;36(1):23-31.

"... acute neurological injury ... All 15 studies found that brain temperature was HIGHER than all measures of core temperature with mean differences of 0.39 to 2.5 degrees C reported."
(emph. added j.t.)



The following references were, subsequently, brought to my attention:

Neurovascular Dysfunction and Neurodegeneration in Dementia and Alzheimer's Disease
by: Amy R Nelson, et al.
Biochim Biophys Acta May 2016
PMID: 26705676
PMCID: PMC4821735
DOI: 10.1016/j.bbadis.2015.12.016

"Vascular insults can initiate a cascade of molecular events leading to neurodegeneration, cognitive impairment, and dementia ..."


...Aged Rats Subjected to CHRONIC Cerebral Hypoperfusion
by: Amanda Santiago et al.
Neuropharmacology 2018 Aug;138:360-370
doi: 10.1016/j.neuropharm.2018.06.019
Epub 2018 Jun 19

"CHRONIC cerebral hypoperfusion (CCH) has been associated with aging-related vascular dementia, including Alzheimer's disease..."
(emph. added j.t.)


Pathophysiology of Hypoperfusion of the Precuneus
in Early Alzheimer's Disease

by: J Scott Miners et al.
Brain Pathol. 2016 Jul;26(4):533-41
doi: 10.1111/bpa.12331
Epub 2015 Nov 9

"The earliest decline in cerebral perfusion in Alzheimer's disease (AD) ..."


Post-mortem Assessment of Hypoperfusion of Cerebral Cortex in Alzheimer's Disease and Vascular Dementia
by: Taya Thomas et al.
2015 Apr;138(Pt 4):1059-69
doi: 10.1093/brain/awv025
Epub 2015 Feb 16

"Perfusion is reduced in the cerebral neocortex in Alzheimer's disease ..."


Cerebral Hypoperfusion and the Energy Deficit in Alzheimer's Disease
by: Seth Love et al.
Brain Pathol. 2016 Sep;26(5):607-17
doi: 10.1111/bpa.12401

"There is a perfusion deficit in Alzheimer's disease (AD) ... The deficit anticipates the development of dementia, contributes to brain damage, and is caused by both functional and structural abnormalities of the cerebral vasculature ..."


Astroglial and Cognitive Effects of CHRONIC Cerebral Hypoperfusion in the Rat
by: Evelin Vicente et al.
Brain Res. 2009 Jan 28;1251:204-12
doi: 10.1016/j.brainres.2008.11.032
Epub 2008 Nov 19

"significant reduction of cerebral blood flow (hypoperfusion) in rats [and] constitutes a well established experimental model to investigate neuronal damage and cognitive impairment that occurs in human ageing and Alzheimer's disease ..."
(emph. added j.t.)


"cerebral blood flow ... is useful in the early diagnosis of dementia."
By: Niwa F, et al.
Intern Med. 2016;55(24):3571-3578. Epub 2016 Dec 15


"... brain blood flow deficits are one of the earliest detectable symptoms of dementia."
By: Jean C.Cruz Hernandez et al.
published in Nature Neuroscience


"... Alzheimer's disease is associated with a 20-30% reduction in cerebral blood flow ..."
By: Bracko O, et al.
J Cereb Blood Flow Metab. 2019


"Cerebral blood flow (CBF) reductions in Alzheimer’s disease patients and related mouse models have been recognized for decades ..."
By: Jean C. Cruz, et al.
Nature Neuroscience
volume 22, pages: 413-420 (2019)


Late-Onset Dementia: Structural Brain Damage and Total CerebralBlood Flow
By: Aart Spilt MD, et al.
RadiologyVolume 236, Issue 3Sep 1 2005

"... blood flow in the brain was 742 milliliters per minute among the healthy, young adults ... among the dementia group was 443 milliliters per minute ... In patients with dementia, cerebral blood flow was 108 mL/min lower than that in subjects of the same age with optimal cognitive function ..."


From CHRONIC cerebral hypoperfusion to Alzheimer-like brain pathology and neurodegeneration
By: Yang Zhao et al.
Cell Mol Neurobiol. 2015 Jan
PMID: 25352419
DOI: 10.1007/s10571-014-0127-9

"Recent studies have revealed an important role of CHRONIC cerebral hypoperfusion (CCH) in neurodegeneration and dementia, including vascular dementia and Alzheimer's disease ..."
(emph. added j.t.)


...CHRONIC cerebral hypoperfusion-related neurodegenerative diseases ...
By: Eszter Farkas et al.
Brain Res Rev
2007 Apr;54(1):162-80
doi: 10.1016/j.brainresrev.2007.01.003
Epub 2007 Jan 18

"...the pattern of cerebral blood flow in mild cognitive impairment has emerged as a PREDICTIVE MARKER for the progression into Alzheimer's disease ..."
(emph. added j.t.)


Brain hypoperfusion: a critical factor in vascular dementia
By: Gustavo C Roman
Neurol Res
2004 Jul;26(5):454-8
doi: 10.1179/016164104225017686

"... hypoperfusion explain the high risk for the development of cognitive impairment and vascular dementia in older patients ..."


CHRONIC cerebral hypoperfusion: a key mechanism leading to vascular cognitive impairment and dementia
By: Jessica Duncombe et al.
Clin Sci (Lond)
2017 Sep 28;131(19):2451-2468
doi: 10.1042/CS20160727
Print 2017 Oct 1

"... it appears that cerebral hypoperfusion is the common underlying pathophysiological mechanism which is a major contributor to cognitive decline and degenerative processes leading to dementia ..."
(emph. added j.t.)


Post-mortem assessment of hypoperfusion of cerebral cortex in Alzheimer's disease and vascular dementia
By: Taya Thomas et al.
Brain 2015 Apr;138(Pt 4):1059-69
doi: 10.1093/brain/awv025
Epub 2015 Feb 16

"Perfusion is reduced in the cerebral neocortex in Alzheimer's disease ..."


The role of CHRONIC brain hypoperfusion in the pathogenesis of Alzheimer's disease--facts and hypotheses
By: Denes Zadori et al.
Ideggyogy Sz.
2007 Nov 30;60(11-12):428-37

"...[brain] Hypoperfusion leads to the degeneration of capillaries ..."
(emph. added j.t.)


The impact of cerebrovascular aging on vascular cognitive impairment and dementia
By: Tuo Yang et al.
Ageing Res Rev.
2017 Mar;34:15-29
doi: 10.1016/j.arr.2016.09.007
Epub 2016 Sep 28

"... One of the major of types of cognitive dysfunction due to CHRONIC cerebral hypoperfusion is vascular cognitive impairment and dementia ..."
(emph. added j.t.)


Cerebrovascular disease in ageing and Alzheimer's disease
By: Seth Love et al.
Acta Neuropathol
2016 May;131(5):645-58
doi: 10.1007/s00401-015-1522-0
Epub 2015 Dec 28

"Cerebrovascular disease (CVD) and Alzheimer's disease (AD) have more in common than their association with ageing ..."


CHRONIC cerebral hypoperfusion alters Beta Amyloid peptide pools leading to cerebral amyloid ...
Natalia Salvadores et al.
By: Clin Sci (Lond)
2017 Jul 24;131(16):2109-2123
doi: 10.1042/CS20170962
Print 2017 Aug 15

"Cerebral hypoperfusion is an early feature of Alzheimer's disease (AD) that influences the progression from mild cognitive impairment to dementia ... We suggest that in response to hypoperfusion, increased Beta Amyloid production/deposition ..."
(emph. added j.t.)


Are Major Dementias Triggered by Poor Blood Flow to the Brain?
By: Jack C de la Torre
J Alzheimers Dis. 2017 57 (2), 353-371
PMID: 28211814
DOI: 10.3233/JAD-161266

"There is growing evidence that chronic brain hypoperfusion plays a central role in the development of Alzheimer's disease (AD) LONG BEFORE dyscognitive symptoms or amyloid accumulation in the brain appear ..."
(emph. added j.t.)