Einfluss vaskulärer Komorbiditäten auf die antioxidative Abwehr bei Alzheimer-Demenz

 

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Zusammenfassung

Hintergrund und Fragestellung: Die Bildung von reaktiven Sauerstoffspezies (ROS) im Organismus spielt eine wichtige Rolle bei der Entstehung der Demenz. Jedoch ist die Rolle des Ungleichgewichtes zwischen Oxidanzien und Antioxidanzien bezüglich vaskulärer Erkrankungen bei der Alzheimer-Krankheit noch unklar. Ziel der Studie war es, einen Zusammenhang zwischen vaskulären Komorbiditäten und Plasmaspiegeln antioxidativer Mikronährstoffe bei Patienten mit Alzheimer-Demenz zu untersuchen.

Patienten und Methodik: In die Studie wurden 41 Patienten mit Alzheimer-Demenz und 34 Kontrollpersonen aufgenommen. Bei 21 der Patienten mit Alzheimer-Demenz wurden zusätzlich Atherosklerose (erhöhte Intima-Media-Dicke der Arteria carotis communis) und/oder Diabetes mellitus Typ 2 diagnostiziert (AD-Plus-Gruppe). Dagegen waren 20 Patienten mit Alzheimer-Demenz frei von vaskulären Komorbiditäten und Risikofaktoren (AD-Gruppe). Bei allen Studienteilnehmern wurden neuropsychologische Untersuchungen (Mini-Mental-State-Test, MMST; Uhrentest; DemTect) durchgeführt und die Plasmaspiegel folgender lipophiler Mikronährstoffe mittels Hochdruck-Flüssigkeitschromatographie (HPLC) bestimmt: Retinol (Vitamin A), α-Tocopherol (Vitamin E), Lutein, Zeaxanthin, β-Cryptoxanthin, Lycopin, α-Carotin und β-Carotin.

Ergebnisse: Die Plasmaspiegel von Retinol, α-Tocopherol, Lutein, Zeaxanthin, Lycopin und β-Carotin waren in der AD-Plus-Gruppe im Vergleich zur Kontrollgruppe signifikant niedriger. Darüber hinaus war der Vitamin-A-Spiegel mit dem Ergebnis des MMST signifikant korreliert; eine signifikante Assoziation mit allen neuropsychologischen Testergebnissen bestand für Vitamin E, Lutein, Zeaxanthin und Lycopin.

Folgerung: Bei Patienten mit einer Alzheimer-Demenz ist die Konzentration antioxidativ wirksamer Mikronährstoffe im Blut bei gleichzeitig vorhandenen vaskulären Erkrankungen und Risikofaktoren erniedrigt. Die vaskuläre Komponente der Alzheimer-Demenz hängt möglicherweise mit einer Depletion der Antioxidanzien zusammen. Vaskuläre und andere Begleiterkrankungen sollten als Risikofaktor für verminderte antioxidative Netzwerke angesehen werden und deshalb diagnostisch und therapeutisch bei Patienten mit Alzheimer-Demenz besondere Beachtung finden.

Abstract

Background and aim: Oxidative stress is a critical factor in the pathophysiology of dementia, but the role of oxidant/antioxidant imbalance in relation to vascular pathology in the onset and progression of Alzheimer’s disease (AD) is poorly understood. The aim of this study was the identification of an association between vascular comorbidities/vascular risk factors and plasma levels of antioxidant micronutrients in patients with AD.

Patients and methods: 41 patients with AD  and 34 controls were included in the study. Atherosclerosis (increased intima-media thickness of the common carotid artery) and/or type 2 diabetes mellitus were diagnosed in 21 AD  patients (AD  Plus group). 20 patients with AD were free of vascular comorbidities and risk factors (AD group). A neuropsychological assessment (Mini-Mental State Examination, MMSE; Clock drawing test; DemTect) and the measurement of plasma levels of lipophilic micronutrients including retinol (vitamin A), α-tocopherol (vitamin E), lutein, zeaxanthin, β-cryptoxanthin, lycopene, α-carotene and β-carotene by HPLC were performed in all study subjects.

Results: Plasma levels of retinol, vitamin E, lutein, zeaxanthin, lycopene and β-carotene were significantly lower in the AD  Plus group than in controls. Furthermore, vitamin A levels were correlated with MMSE scores and the levels of vitamin E, lutein, zeaxanthin and lycopene were correlated with all neuropsychological tests.

Conclusion: The depletion of circulating antioxidant micronutrients observed in AD  patients is associated with vascular comorbidities and risk factors. The vascular comorbidities of patients with AD should also be identified in light of the presence and degree of depletion of the antioxidant defense system of the organism. This might lead to a better lifestyle-related counselling of patients with AD  and their caregivers, with possible positive preventive effects on worsening in the long run. Further studies with a larger patient sample are needed to verify the negative effect of vascular pathology in AD-related oxidative stress.

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