Effect of Vascular Lesions on Cognition in Alzheimer's Disease: a Community-based Study

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2004 Sep 3

PMID 15341544

Citations 37

Authors

Robert G Riekse

James B Leverenz

Wayne McCormick

James D Bowen

Linda Teri

David Nochlin

Kate Simpson

Charisma Eugenio

Eric B Larson

Debby Tsuang

Affiliations

Soon will be listed here.

Abstract

Objectives: To investigate whether clinical and neuropathological differences exist between Alzheimer's disease (AD) cases with and without vascular lesions neuropathologically diagnosed using Consortium to Establish a Registry for Alzheimer's Disease (CERAD) criteria.

Design: Descriptive observational study.

Setting: A community-based registry that identified incident dementia cases.

Participants: Of the 124 subjects with available clinical and neuropathological assessments, 30 had AD lesions alone, and 18 had AD with vascular lesions. Patients with other neuropathological findings were excluded.

Measurements: Dependent measures included demographic, clinical, and neuropathological characteristics. Neuropathological diagnoses were made using the CERAD criteria and Braak and Braak staging.

Results: Of the 124 autopsied cases, 85 cases were diagnosed with neuropathological AD. Of these, 30 had pathology consistent with "pure" AD, whereas 18 had AD pathology with significant vascular lesions (AD/V). There were no differences in age, sex, or education between groups. AD/V cases had higher baseline and final Mini-Mental State Examination (MMSE) scores than pure AD cases, but after adjusting for education, differences in MMSE scores were not statistically significant. The AD/V group had significantly lower Braak staging than the pure AD group, after adjusting for education and final MMSE scores.

Conclusion: In this comparison study of AD cases with and without vascular lesions, AD/V cases had less severe AD pathology than those with AD alone, indicating that cerebrovascular disease likely contributes to the severity of cognitive impairment in those with AD. Controlling for vascular risk factors in patients with AD may have a significant effect on severity of dementia.

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