Characteristics of brain computed tomography in dementia with cardiovascular disease and psychological and behavioral symptoms

Objective To describe brain computed tomography (CT) features in Alzheimer’s disease (AD) with comorbid cardiovascular diseases (CVDs) and examine associations with behavioral and psychological symptoms (BPSD). Methods This single-center, hospital-based observational case-control study (August 2019–May 2021) used consecutive sampling. We enrolled 165 older adults with AD and CVDs (CVD group), 165 older adults with AD without CVDs (AD-only group), and 165 cognitively healthy older adults (healthy controls). All participants underwent non-contrast brain CT at baseline. Qualitative CT findings cortical atrophy, widened sulci, and medial hippocampal cerebrospinal fluid (CSF) pool widening and quantitative parameters (lateral split brain width, frontal sulcus width, lateral ventricle width, third ventricle width, forehead index, and caudate nucleus index) were compared across groups. Diagnostic performance for AD (AD groups vs. healthy controls) was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). BPSD were assessed with the Neuropsychiatric Inventory Questionnaire (NPI-Q), and correlations between NPI-Q scores and CT parameters were analyzed in the CVD group. Results Qualitative CT abnormalities were more frequent in both AD groups than in healthy controls ( p 0.05) but did not differ between the CVD and AD-only groups ( p 0.05). Quantitative CT parameters showed a similar pattern: both AD groups differed from healthy controls ( p 0.05), while comparisons between the two AD groups were not significant ( p 0.05). The combined diagnostic AUC for AD was 0.881. In the CVD group, higher NPI-Q total scores were associated with decreased lateral split brain width and increased frontal sulcus width, lateral ventricle width, third ventricle width, forehead index, and caudate nucleus index (all p 0.05). Conclusion AD participants, with or without CVD comorbidity, showed significant CT abnormalities compared with healthy controls. In AD with CVDs, quantitative CT parameters were associated with BPSD severity.