Joseph Rapp, MD
Staff Physician, Chief of Vascular Surgery Service, SFVAMC
Professor of Surgery, UCSF
Email: joseph.rapp@ucsf.edu
Investigating Causes of Vascular Dementia
Vascular dementia is recognized as a common cause of intellectual deterioration in the elderly. While it can occur after stroke, it is also thought to occur as the result of lesions in the brain caused by hypertension. However, microemboli (tiny blood clots) in the brain, originating from the heart or carotid arteries, cause lesions similar to those occurring from hypertension. Microemboli frequently occur in the elderly population and Dr. Rapp hypothesizes that these are an unrecognized cause of vascular dementia. His research has shown that microemboli cause small breaks in the blood-brain barrier, initiate an inflammatory response in the brain, and start a potentially destructive immune response as well. These data suggest that imaging tests such as transcranial Doppler could be used to identify patients at risk for microembolization and to determine the need for aggressive preventive therapy.
Rapp JH, Pan XM, Neumann M, Hong M, Hollenbeck K, Liu J. 2008. Microemboli composed of cholesterol crystals disrupt the blood-brain barrier and reduce cognition. Stroke 39(8):2354-61.
Rapp JH, Zhu L, Hollenbeck K, Sarkar R, Velez PM, Reilly LM, Hiramoto J, Pan XM. 2009. Distal filtration versus flow reversal: An ex vivo assessment of the choices for carotid embolic protection. J Vasc Surg (Epub ahead of print).
