Alzheimer's Disease

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Abstract

Dear Sir: There is a great increase in Alzheimer’s disease research in the past few years and arteriosclerosis appears to be ignored as a causative factor. It was, therefore, a great surprise to me when reviewing a translation of Alzheimer’s original paper “on a Peculiar Disease of the Cerebral Cortex” (1) to dis­ cover that his patient, though only 51 years old, had arterio­ sclerosis. The report states she had “somewhat rigid radial arteries” and “The large cerebral vessels were altered by arteriosclerosis”. The evidence of arteriosclerosis at these sites would make one suspect its possible presence in the carotid and vertebral arteries as well. Such arteriosclerotic stenoses could cause cerebrovascular insufficiency which would explain this woman’s fluctuating and progressive symptoms. Reduction of the general volume of blood flow to the brain by arterial narrowing results in insufficient blood to fill all the capillaries and this could account for Alzheimer’s finding that “Scattered through the entire cortex, especially in the upper layers, one found miliary foci”. Alzheimer’s explanation that they “were caused by the doposition of a peculiar substance” may not be correct. They may rather have been due to multiple areas of focal ischemia. There is further evidence of vascular problems: “one saw evidence of endothelial proliferation and also neovascularization in some places”. In view of the above findings it is perhaps premature to rule out circulatory factors, especially since we now know about the importance of the extracranial circulation. In addition, thanks to the research of the late Professor Melvin Knisely (2), we know that blood sludging occurs when the blood flow slows too much and this blocks off the microcirculation. Such blockage could explain the “miliary foci” found by Alzheimer in his patient’s brain.