title: Cortical microinfarcts and demyelination affect cognition in cases at high risk for dementia.
abstract: OBJECTIVE
  To investigate the possible synergistic effect of microvascular lesions with mild Alzheimer disease (AD) pathology in mixed cases.
  
  
  METHODS
  We assessed the cognitive impact of cortical microinfarcts, deep white matter and periventricular demyelination, as well as diffuse and focal gliosis in a large series of 43 prospectively evaluated autopsy cases scored Braak neurofibrillary tangle stage III, but without macroscopic vascular pathology or substantial non-AD, nonvascular microscopic lesions. We included bilateral assessment of all types of microvascular lesions and used multivariate models that control for the possible confounding effect of age and amyloid beta-protein (Abeta) deposits.
  
  
  RESULTS
  Only cortical microinfarcts and periventricular demyelination were significantly associated with the Clinical Dementia Rating Scale (CDR) score. In a univariate model, the cortical microinfarct score explained 9% of the variability in CDR scores and periventricular demyelination score 7.3%. Abeta deposition explained only 3.5% of the CDR variability. In a logistic regression model, both variables were strongly associated with the presence of dementia (R = 0.45; p < 0.05). When the CDR sum of the boxes was used, Abeta staging explained 8.9% of cognitive variability, the addition of cortical microinfarct predicted an extra 15.5%, and that of periventricular demyelination an extra 9%.
  
  
  CONCLUSIONS
  Cortical microinfarcts and, to a lesser degree, periventricular demyelination contribute to the cognitive decline in individuals at high risk for dementia. Both should be taken into account when defining the neuropathologic criteria for mixed dementia.
authors: Department of Psychiatry, University of Geneva School of Medicine, Chêne-Bourg, Switzerland. eniko.kovari@hcuge.ch
authors: E
authors: E
authors: Kövari
authors: G
authors: G
authors: Gold
authors: F R
authors: FR
authors: Herrmann
authors: A
authors: A
authors: Canuto
authors: P R
authors: PR
authors: Hof
authors: C
authors: C
authors: Bouras
authors: P
authors: P
authors: Giannakopoulos
mesh_terms: D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D003704:Dementia / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D003711:Demyelinating Diseases / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D015999:Multivariate Analysis; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D016874:Neurofibrillary Tangles / Q000473:pathology; D058225:Plaque, Amyloid / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors