Is Beta-Amyloid Accumulation a Cause or Consequence of Alzheimer's Disease?

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that is characterized by the pathological hallmarks of extracellular beta-amyloid (Aβ) plaques and intraneuronal tau-containing neurofibrillary tangles in the brain. Intraneuronal accumulation of Aβ also plays a role to accelerate AD progression by promoting neurodegeneration. Additionally, AD is associated with the development of amyloid angiopathy (CAA), in which Aβ builds up on the walls of the cerebral arteries, which augments the development of cerebral vascular disease (CVD). Conversely, CVD promotes Aβ deposition and the development of AD by affecting the balance of Aβ production and clearance. However, it remains to be determined whether the accumulation of Aβ is a cause or consequence of AD. The interaction between AD and CVD is a topic of considerable current interest. Here, we discuss the role of CVD in Aβ accumulation and the development of AD to provide a new point of view that combination therapies that address the accompanying cerebral microvascular disease may potentiate the efficacy of emerging treatment for AD.