Effect of vascular lesions on cognition in Alzheimer's disease: a community-based study.
OBJECTIVE
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.


METHODS
Descriptive observational study.


METHODS
A community-based registry that identified incident dementia cases.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Riekse
Robert G
RG
Department of Medicine, University of Washington, Seattle, Washington, USA. riekse@u.washington.edu
Leverenz
James B
JB
McCormick
Wayne
W
Bowen
James D
JD
Teri
Linda
L
Nochlin
David
D
Simpson
Kate
K
Eugenio
Charisma
C
Larson
Eric B
EB
Tsuang
Debby
D
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003071:Cognition; D015897:Comorbidity; D015140:Dementia, Vascular / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D014861:Washington / Q000453:epidemiology