2023-10-08 02:36:44
A work led by researchers from the Hospital del Mar Research Institute in Barcelona identifies that the deterioration of the blood-brain barrier, which regulates exchanges between blood and the brain, can serve to identify which of these patients will have a more rapid evolution.
In the patients analyzed, the risk of accelerated disease progression increases by 8% for every 10% increase in the albumin index in cerebrospinal fluid and blood (biomarker of damage to the blood-brain barrier). Results indicate that restoring the blood-brain barrier’s ability to protect the brain could help slow patients’ worsening
This marker will allow a more precise assessment of the prognosis of patients with cognitive impairment caused by Alzheimer’s and other dementias. The work is published by the magazine Alzheimer’s&Dementia
This study has described, for the first time, a marker that can help predict which patients with Alzheimer’s or other types of dementia will suffer a more rapid progression of the disease. This is the degree of deterioration of the blood-brain barrier, which regulates exchanges between blood and the brain and protects it from possible attacks and infections.
The first signatory of the work, Albert Puig-Pijoan, researcher at the Hospital del Mar Research Institute and assistant physician at the Neurology Service at Hospital del Mar, points out that in this study “we have been able to see if the increase in the permeability of the blood-brain barrier is a good predictor or if it is associated with a different prognosis in patients with cognitive impairment.” Until now, few markers were available to predict which patients diagnosed with Alzheimer’s or other dementias would have a more rapid evolution.
To check whether the state of the blood-brain barrier serves as a predictor, more than 300 patients from the BIODEGMAR cohort at Hospital del Mar have been followed for four years. These people had been diagnosed with mild cognitive impairment or dementia, caused by different neurodegenerative diseases such as Alzheimer’s or cerebrovascular disease. For its diagnosis, there was a clinical evaluation accompanied by a neuropsychological evaluation, as well as data extracted from a lumbar puncture and an MRI. To see their evolution, clinical visits and neuropsychological assessments were made during follow-up.
These people had been diagnosed with different neurodegenerative pathologies, such as Alzheimer’s or cerebrovascular disease, but also mild cognitive impairment. To see its evolution, we had data extracted from a lumbar puncture, accompanied by a neuropsychological assessment and an MRI.
The results indicate that those in whom higher levels of albumin were detected in the cerebrospinal fluid in the lumbar puncture compared to the levels in the blood, an indicator of an increase in permeability and, therefore, of the deterioration of the protective function of the blood-brain barrier, the evolution of the disease is more accelerated. In the patients analyzed, the risk of accelerated progression of the disease increases by 8% for every 10% increase in this indicator in the cerebrospinal fluid.
The origin, vascular damage
The researchers highlight that there are different clinical and biological factors that can affect the ability of the blood-brain barrier to protect the brain. The most common in the population studied are being male, cardiovascular risk factors, especially diabetes, and the presence of signs of vascular injury detected through magnetic resonance imaging. “The hypothesis is that vascular damage causes this alteration in permeability, a fact that causes an acceleration of the cognitive deterioration caused by the disease that causes dementia,” explains Ángel Ois, the last signatory of the study, researcher at the Hospital del Mar Research Institute and neurologist at Hospital del Mar.
One of the advantages of this marker is that it is relatively simple to check albumin levels in the cerebrospinal fluid and blood. This makes it a good indicator that opens the door to researching new approaches to slow the progression of these diseases. Influence cardiovascular protective factors to preserve the protective capacity of the blood-brain barrier or investigate to find treatments that restore it to improve the prognosis of patients. This is pointed out by Puig-Pijoan, who assures that the results obtained “are indicating to us that vascular risk factors and cerebrovascular damage are two of the main mechanisms involved in cognitive deterioration, not only in Alzheimer’s. Therefore, focusing on the prevention of these risk factors and potentially having targeted therapies can be a very interesting avenue to explore.”
The research will continue with larger and more specific cohorts to validate this marker in different pathologies and search for new variables that allow establishing the rate of evolution of people diagnosed with some type of dementia. This study may also allow more careful monitoring of patients based on their condition, even those with mild cognitive impairment, but without a defined diagnosis. M.T.T. (SyM)
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