title: Effect of infarcts on dementia in the Baltimore longitudinal study of aging.
abstract: OBJECTIVE
  To define the magnitude and mechanism of the effect of brain infarcts on the odds of dementia in a prospective study.
  
  
  METHODS
  We examined the effects of brain infarcts and Alzheimer's disease (AD) pathology on the risk for dementia in 179 subjects from the Baltimore Longitudinal Study of Aging Autopsy Program. All subjects had longitudinal clinical and cognitive evaluations, and underwent postmortem examination of the brain.
  
  
  RESULTS
  Brain infarcts were common in our cohort, and both symptomatic and asymptomatic infarcts conferred a significant increase in the odds of dementia. Risk factors for stroke in the absence of an infarct did not increase the odds of dementia, which was quantitatively related to the number but not the size of hemispheral infarcts; deep subcortical infarcts conferred no increased risk for dementia. The contribution of microscopic infarcts to dementia was significant and equivalent to that of macroscopic infarcts. In subjects with intermediate AD pathology scores, a single macroscopic hemispheral infarct was sufficient to cause dementia. A logistic regression model of the effect of infarcts and AD pathology on dementia indicated that AD pathology alone accounts for 50% of the dementia seen in this cohort, and that hemispheral infarcts alone or in conjunction with AD pathology account for 35%.
  
  
  CONCLUSIONS
  Cerebrovascular disease is a significant and potentially preventable cause of dementia in the Baltimore Longitudinal Study of Aging. Burden and location of infarcts are significantly associated with cognitive decline.
authors.affiliation: Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Troncoso
authors.forename: Alan B
authors.initials: AB
authors.lastname: Zonderman
authors.forename: Susan M
authors.initials: SM
authors.lastname: Resnick
authors.forename: Barbara
authors.initials: B
authors.lastname: Crain
authors.forename: Olga
authors.initials: O
authors.lastname: Pletnikova
authors.forename: Richard J
authors.initials: RJ
authors.lastname: O'Brien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000544:Alzheimer Disease / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015142:Baltimore / Q000453:epidemiology; D002544:Cerebral Infarction / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D015331:Cohort Studies; D003704:Dementia / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors