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Semin Thromb Hemost 2019; 45(05): 514-522
DOI: 10.1055/s-0039-1688444
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hemostatic Abnormalities in Dementia: A Systematic Review and Meta-Analysis

Cristina de Mello Gomide Loures
1   Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
,
Rita Carolina Figueiredo Duarte
1   Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
,
Marcos Vinícius Ferreira Silva
1   Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
,
Walter Batista Cicarini
1   Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
,
Leonardo Cruz de Souza
2   Department of Medical Clinic, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
,
Paulo Caramelli
2   Department of Medical Clinic, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
,
Karina Braga Gomes Borges
1   Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
,
Maria das Graças Carvalho
1   Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
› Author Affiliations
Funding CNPq, CAPES, and FAPEMIG agencies provided financial support. LCS, PC, KBG and MGC are grateful to CNPq Research Fellowship.
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Publication History

Publication Date:
16 May 2019 (online)

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Abstract

Alzheimer's disease (AD) is considered the most frequent cause of dementia. It is known that vascular risk factors play an important role in the development and progression of this condition. Alterations in vascular walls represent documented findings in patients with AD and other dementias affecting elderly people. The authors performed a systematic review and meta-analysis, aiming to synthesize observational studies that evaluated how the hemostatic system may contribute to cognitive decline in the elderly, using papers published until April 2018 and as indexed in Medline (PubMed), Scopus, Web of Science, ScienceDirect, Lilacs, Cinahl, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Among 5,278 studies identified, 32 were included in the final synthesis, and these included 485 patients with mild cognitive impairment, 568 with vascular dementia (VD), 1,781 with AD, and 2,855 participants without dementia. AD patients had increased plasma von Willebrand factor (VWF) (standardized mean difference [SMD]: 2.53; 95% confidence interval [CI]: 0.10–4.95), D-dimer (SMD: 0.50; 95% CI: 0.35–0.66), plasminogen activator inhibitor-1 (SMD: 3.34; 95% CI: 1.01–5.67), thrombomodulin (SMD: 1.08; 95% CI: 0.53–1.62), and homocysteine levels (SMD: 0.65; 95% CI: 0.15–1.15). In contrast, the VD group showed increased fibrinogen levels (SMD: 0.77; 95% CI: 0.13–1.41), activated factor VII (SMD: 0.36; 95% CI: 0.05–0.67), factor VIII (SMD: 0.57; 95% CI: 0.22–0.91), VWF (SMD: 2.34; 95% CI: 0.38–4.29), D-dimer (SMD: 1.14; 95% CI: 0.51–1.78), and homocysteine (SMD: 2.17; 95% CI: 1.67–2.68). AD showed an elevation in some markers of endothelial dysfunction, whereas VD presented mostly an involvement of coagulation cascade components.

Keywords

alzheimer's disease - cognitive decline - dementia - hemostasis

Author Contribution

C. M. G. Loures collected the data, analyzed the data, and drafted the manuscript. R. C. F. Duarte and M. V. F. Silva collected the data. W. B. Cicarini assisted in the statistical analysis. L. C. Souza, P. Caramelli, and K. B. G. Borges contributed to the revision of the manuscript. M. G. Carvalho contributed to the handwriting and revision of the manuscript. The manuscript has been read and approved for submission to Journal of Thrombosis and Haemostasis by all authors.


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