title: Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension.
abstract: OBJECTIVE
  To determine if severe cerebral amyloid angiopathy (AA) in patients with Alzheimer's disease (AD) is associated with an increased prevalence of cerebral infarction diagnosed at autopsy. Amyloid angiopathy is increasingly recognized as a cause of ischemic infarcts, as well as cerebral hemorrhages. However, the relationship of AA to cerebral infarction in patients with AD is uncertain.
  
  
  METHODS
  Retrospective clinicopathological study of autopsy-confirmed cases of AD.
  
  
  METHODS
  One hundred forty-five deceased patients with AD confirmed at autopsy.
  
  
  METHODS
  Semiquantitative scores of AA severity were done in four brain regions: midfrontal, inferior parietal, superior temporal, and hippocampal. The finding of cerebral infarction at autopsy was modeled as a function of AA severity, hypertension, age at death, AD severity, and sex in chi 2 and multiple logistic regression analyses.
  
  
  RESULTS
  Severe AA was significantly associated with cerebral infarction at autopsy in patients with AD (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.4 to 8.9). None of the other independent variables in the multiple logistic regression analysis were significant predictors. While hypertension was equally common in the severe and mild AA subgroups, the combination of both severe AA and hypertension interacted to increase the risk of infarction (OR, 14.2; 95% CI, 3.2 to 63.4) beyond that observed with hypertension (OR, 1.1; 95% CI, 0.4 to 3.2) or severe AA (OR, 1.3; 95% CI, 0.3 to 5.3) alone.
  
  
  CONCLUSIONS
  Severe AA is associated with an increased frequency of cerebral infarction in patients with AD. This appears to be largely due to an interaction between severe AA and hypertension that may produce multiplicative injuries on the vasculature. Further study with regard as to how AA may cause ischemia and its role in the neuropathologic and clinical progression of AD is needed.
authors.affiliation: Alzheimer's Disease Research Center, University of California-San Diego, La Jolla, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Olichney
authors.forename: L A
authors.initials: LA
authors.lastname: Hansen
authors.forename: C R
authors.initials: CR
authors.lastname: Hofstetter
authors.forename: M
authors.initials: M
authors.lastname: Grundman
authors.forename: R
authors.initials: R
authors.lastname: Katzman
authors.forename: L J
authors.initials: LJ
authors.lastname: Thal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000473:pathology; D001921:Brain / Q000473:pathology; D016657:Cerebral Amyloid Angiopathy / Q000150:complications* / Q000473:pathology; D002544:Cerebral Infarction / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000473:pathology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors