title: Coexisting cerebral infarction in Alzheimer's disease is associated with fast dementia progression: applying the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences Neuroimaging Criteria in Alzheimer's Disease with Concomitant Cerebral Infarction.
abstract: OBJECTIVE
  To determine whether patients with Alzheimer's disease (AD) and coexisting cerebral infarction (CI) that satisfy the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) neuroimaging criteria for vascular dementia (VaD) progress faster than those who do not satisfy the neuroimaging criteria.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Multidisciplinary memory clinic in a tertiary hospital.
  
  
  METHODS
  One hundred thirty consecutive patients with AD, with or without CI, followed up regularly for more than 1 year.
  
  
  METHODS
  The patients were classified according to the distribution and severity of CI as defined according to the NINDS-AIREN neuroimaging criteria into those with AD and no CI (AD-N), those with AD and CI not fulfilling neuroimaging criteria (AD-I), and those with AD and CI fulfilling neuroimaging criteria (AD-V), and their differences in dementia progression were tested. The loss of independence, indicated by institution admission or a clinical dementia rating (CDR) score of 3, was defined as the endpoint for a poor outcome.
  
  
  RESULTS
  The mean age was 75.8, and 68.5% were women. The initial Mini-Mental State Examination (MMSE) score was 15.3+/-0.4, and the average duration of follow up was 30.4 months. Fifty-four patients had reached study endpoint at the time of analysis. AD-V (hazard ratio (HR)=3.1, 95% confidence interval (CI)=1.2-8.2), use of psychotropic drugs (HR=2.7, 95% CI=1.1-6.4), and initial MMSE score (HR=0.9, 95% CI=0.8-1.0) were independent predictors of poor outcome in the Cox regression model.
  
  
  CONCLUSIONS
  In AD, co-occurrence of CI with distribution and severity as defined in the NINDS-AIREN neuroimaging criteria for VaD is associated with faster dementia progression.
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong. shengbun@hotmail.com
authors.forename: Bun
authors.initials: B
authors.lastname: Sheng
authors.forename: Lik Fai
authors.initials: LF
authors.lastname: Cheng
authors.forename: Chun Bon
authors.initials: CB
authors.lastname: Law
authors.forename: Ho Lun
authors.initials: HL
authors.lastname: Li
authors.forename: Kwan Mo
authors.initials: KM
authors.lastname: Yeung
authors.forename: Kwok Kwong
authors.initials: KK
authors.lastname: Lau
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000523:psychology*; D002544:Cerebral Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000523:psychology*; D015331:Cohort Studies; D015140:Dementia, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed