Introduction: Alzheimer's disease is a neurodegenerative disease that initially manifests itself primarily as impaired short-term memory and impaired language ability. The course of the disease is mainly due to an atrophy in the brain that can be attributed to the protein amyloid B and tau. Monoclonal antibodies that target Alzheimer's disease often have a high rate of cerebral edema, where proteinaceous fluid leaks into the extracellular space of the brain and creates edema. Some of the most common symptoms for amyloid-related imaging abnormalities (ARIA-E) are headache, dizziness, and blurred vision. In a few cases, patients with ARIA-E need to be hospitalized for observation, but most show a decline in ARIA-E within one to two months. Objective: To investigate the frequency of ARIA-E in clinical studies of monoclonal antibodies to patients with Alzhiemer's disease and to investigate the role of the ApoE4 allele in the development of ARIA-E. Method: Literature review of five RCT studies based on four different monoclonal antibodies. PubMed was used to search for the RCT-studies. Results: ARIA-E varies between different types of antibodies. ARIA-E usually occurs early in treatment when the degree of amyloid b is highest in the brain. Most cases are asymptomatic and treatment resumes within 1-2 months. Conclusion: Aria-E frequency correlates strongly with dose strength as well as APOE4 -status and most of the incidences are asymptomatic. With the right titration and individually selected drugs as well as individual dosages a safe care can be established for patients with Alzheimer's disease. If treatment is initiated at an early stage, the risk of side effects is reduced and more neurons can be saved from atrophy. The combination of several different types of medicine will further reduce the risk of ARIA-E.

En aquest treball de tesis doctoral s'estudia el paper de l'estrès oxidatiu tant a la etiologia com a la patofisiologia del dany vascular associat a la malaltia d'Alzheimer. Es demostra la capacitat de les cèl·lules musculars llises vasculars de produir pèptid β-amiloide (Aβ). L'estrès oxidatiu associat a edats avançades, estimula el processament amiloidogènic de l' APP a cèl·lules musculars llises vasculars portant a un augment de producció d' Aβ1-40 i Aβ1-42 contribuint així, a la formació dels depòsits amiloides vasculars. Alhora, els depòsits amiloides vasculars indueixen dany vascular a través d'estrès oxidatiu, a on la nitrotirosinació de proteïnes juga un paper clau en la inactivació d'enzimes essencials per la viabilitat cel·lular. La vitamina E i els estrogens tenen un efecte protector a neurones i cèl·lules musculars llises vasculars mentre que la vitamina E, però no els estrogens, és capaç de protegir les cèl·lules endotelials davant la toxicitat induïda pel pèptid Aβ. / In this thesis we study the effect of oxidative stress in the etiology and pathophysiology of the vascular damage associated to Alzheimer's disease. We demonstrate the production of amyloid-β-peptide (Aβ) by vascular smooth muscle cells. Oxidative stress related to advance ages, induces the amyloidogenic APP cleavage producing an increase of Aβ1-40 and Aβ1-42 by vascular smooth muscle cells, which in tum contribute to vascular amyloid deposits generation. Vascular amyloid deposits induce oxidative stress, in which protein nitrotyrosination plays a key role in essential enzymes inactivation. Vitamin E and estrogens are able to protect neurons and vascular smooth muscle cells while vitamin E, but not estrogens, is able to protect endothelial cells against Aβ-mediated toxicity.