Methods

A randomized controlled clinical trial, including 123 subjects, compared vascular care with standard care in patients with Alzheimer disease with cerebrovascular lesions on MRI.

Progression of WMLs, lacunes, medial temporal lobe atrophy, and global cortical atrophy were semiquantitatively scored after 2-year follow-up.

Results
Sixty-five subjects (36 vascular care, 29 standard care) had a baseline and a follow-up MRI and in 58 subjects, a follow-up scan could not be obtained due to advanced dementia or death.

Subjects in the vascular care group had less progression of WMLs as measured with the WML change score (1.4 versus 2.3, P=0.03).

There was no difference in the number of new lacunes or change in global cortical atrophy or medial temporal lobe atrophy between the 2 groups.

Conclusions

Vascular care in patients with Alzheimer disease with cerebrovascular lesions slows progression of WMLs.

eatment aimed at vascular risk factors in patients with early Alzheimer disease may be beneficial, possibly in an even earlier stage of the disease.
Key Words: Alzheimer • MRI • randomized controlled trial • vascular risk factors • white matter lesions

Stroke. 2010;41:554

Edo Richard, MD; Alida A. Gouw, MD, PhD; Philip Scheltens, MD, PhD Willem A. van Gool, MD, PhD

From the Department of Neurology (E.R., W.A.v.G.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and the Alzheimer Center and the Department of Neurology (A.A.G., P.S.), VU University Medical Center, Amsterdam, The Netherlands.

Correspondence to Edo Richard, MD, Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, Postbus 22660, 1100 DD, The Netherlands. E-mail e.richard@amc.uva.nl