Noninvasive treatment improves cerebral blood flow, cognition in mild Alzheimer’s disease

Moriarty PM, et al. Abstract 1020-11. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).

Moriarty PM, et al. Abstract 1020-11. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).

NEW ORLEANS — A device designed to improve cerebral blood flow with compression of lower limbs synchronized to the cardiac cycle was tied to improved cognitive performance scores in mild cognitive impairment or Alzheimer’s disease.

Reduced cerebral blood flow is an early manifestation of dementia, and vascular risk factors such as hypertension, diabetes, atherosclerosis and Alzheimer’s disease are associated with reduced cerebral blood flow, Patrick M. Moriarty, MD, FACC, FACP, professor of medicine and director of clinical pharmacology and the Atherosclerosis/Lipoprotein-Apheresis Center at the University of Kansas Medical Center, said during a presentation at the American College of Cardiology Scientific Session.

“Cerebral vascular flow plays a significant role in cognitive performance, and treatments improving cerebral blood flow, such as external counterpulsation, may improve cognitive function,” Moriarty told Healio.

Moriarty and colleagues examined the impact of external counterpulsation (ECP) on cognitive performance and cerebral blood flow in adults with mild cognitive impairment and mild Alzheimer’s disease. ECP is a noninvasive outpatient treatment using three pairs of external inflatable cuffs applied around the lower and upper legs and buttocks.

“ECP therapy mimics the benefit of exercise by increasing cardiac output, improving endothelial function, increasing nitric oxide, lowering B-type natriuretic peptide, atrial natriuretic peptide, endothelin-1, angiotensin-converting enzyme, and C-reactive protein, arteriogenesis and angiogenesis, and increasing capillary sprouting,” Moriarty told Healio. “In regards to the cerebral vascular system, in addition to the previously mentioned benefits associated with exercise, ECP lowers blood viscosity and arterial stiffness, resulting in improved cerebral blood flow.”

In a randomized, single-blind, sham-controlled trial, Moriarty and colleagues analyzed data from 190 adults with mild cognitive impairment or mild Alzheimer’s disease from 10 clinical sites. The mean age of participants was 68 years. Within the cohort, 95 participants received 35 ECP treatments for 12 weeks using the Cerezen ECP device (Renew Bioscience), followed by twice weekly maintenance for up to 6 months; 95 participants received a sham treatment.

Compared with those assigned to sham, patients in the treatment group saw improvements from baseline in the Vascular Dementia Assessment Scale cognitive subscale by an average of –4.5 points (P < .05). Researchers observed the greatest benefit among participants with type 2 diabetes who received the treatment (n = 20), who experienced an average –14.6 improvement in the dementia subscale score compared with people with diabetes assigned to sham (n = 15; P < .005).

Cognitive, functional and behavioral performance according to the Alzheimer’s disease Cooperative Study-Clinical Global Impression of Change scale improved among those assigned to ECP compared with those who received sham treatment at 12 weeks (OR = 2.13; 95% CI, 1.18-3.84; P = .013) and at 24 weeks (OR = 2.56; 95% CI, 1.41-4.63; P = .002). Scores for the Alzheimer’s disease Cooperative Study-Activities of Daily Living scale were also greater among participants who received ECP vs. sham (mean change, 2.9 points; posterior probability of superiority = 0.995).

“Decreased cerebral blood flow is the earliest sign of potential cognitive impairment, and every patient with diabetes in the trial, who is generally known to have impaired blood flow, improved their cognition when treated with ECP therapy,” Moriarty told Healio.

Moriarty said the findings support treating vascular flow as a therapeutic target for the treatment of mild cognitive impairment and Alzheimer’s disease.

The device has not yet been studied in a larger trial.