26/07/2025
Dementia patients generally show a mixed pathology, and it has been found that patients diagnosed with Alzheimer disease (AD) often have other pathologies, such as white matter lesions, vascular dementia and LATE (limbic-predominant age-related TDP-43 encephalopathy). A recent large cross-sectional study from Sweden has now shown the reverse: based on cerebrospinal fluid (CSF) biomarkers, an AD pathology was relatively common in people diagnosed with other dementias.
Specifically, an Alzheimer biomarker profile was seen in unspecified dementia, Parkinson's dementia and frontotemporal dementia. Moreover, biomarkers indicating an Alzheimer-like pathology were negatively tied to cognitive function.
While most patients clinically diagnosed with AD had evidence of cerebrospinal fluid (CSF) amyloid and tau pathology, those biomarkers also emerged in people with other dementias, said Tobias Borgh Skillbäck of Sahlgrenska University Hospital in Molndal, Sweden, and co-authors.
In nearly 14,000 adults, a clear, Alzheimer-like profile based on three CSF biomarkers: amyloid-beta 1-42, total tau (t-tau), and phosphorylated tau 181 (p-tau181) was seen in 68% of people with early-onset AD, 65% of late-onset AD, and 52% of people with mixed Alzheimer and vascular dementia.
Among people without an AD diagnosis, the Alzheimer profile emerged in 25% of people with unspecified dementia, 9% of people with Parkinson disease dementia, and 8% of people with frontotemporal dementia.
In several dementias, scores on the Mini-Mental State Examination (MMSE) were associated with CSF biomarkers. MMSE scores were linked with amyloid-beta 1-42 in late-onset AD, vascular dementia, frontotemporal dementia, and unspecified dementia. MMSE scores also were tied to t-tau in late-onset AD, early-onset AD, and unspecified dementia; and linked with p-tau181 in early-onset AD.
This study highlights the complex nature of dementia, with a mixed pathology evident in most people. To my thinking, such findings question the value of trying to find a single drug treatment and imply that a multifactorial approach (as for example via Functional Herbal Therapy) is more rational.
In particular, I feel that Ginkgo biloba is highly underestimated in this context by most clinicians. Its inherent multifactorial activity makes it the best starting point for a complex dementia pathology. Clinical studies have shown that it is neuroprotective and boosts BDNF and Nrf2, is anti-inflammatory, and promotes microcirculation and mitochondrial function. In addition, it is neuroregenerative (used for stroke recovery in China).
For more information see:
http://bit.ly/4kXVmz9
and
https://pubmed.ncbi.nlm.nih.gov/40293734/
