title: Cerebral subcortical small vessel disease in subjects with pathologically confirmed Alzheimer disease: a clinicopathologic study in the Oxford Project to Investigate Memory and Ageing (OPTIMA).
abstract: The understanding of how cerebrovascular disease (CVD) contributes to dementia is hampered by a lack of agreed and validated pathologic methods to accord weight to the contribution of different aspects of CVD to dementia. A previous study from the Oxford Project to Investigate Memory and Ageing (OPTIMA) validated a scheme for assessing the contribution of subcortical small vessel disease (SVD) toward dementia in the elderly by showing a significant inverse relationship between the severity of SVD and cognition in subjects without any other dementia pathology using this method. In the present paper, the method has been used to assess severity of SVD in 161 cases of neuropathologically confirmed Alzheimer disease. The results showed there was no relationship between the SVD score and cognitive scores acquired in the last 2 years of life. SVD scores were significantly related to age (P<0.0017) and were slightly but significantly higher in females than males (P<0.049). SVD scores were not related to blood pressure at entry to OPTIMA and were significantly lower when compared with the cohort of OPTIMA cases with only CVD (mean 5.06 ± 1.85 vs. 5.9 ± 2.67; P<0.0065). We conclude that when Alzheimer disease pathology is present in elderly subjects, it overwhelms the modest contribution that SVD makes to cognitive impairment.
authors.affiliation: *Department of Neuropathology, John Radcliffe Hospital †Nuffield Department of Clinical Neurosciences ‡Nuffield Department of Medicine ∥Department of Pharmacology, Oxford University, Oxford §Department of Pathology, St George's Hospital, University of London, UK.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Esiri
authors.forename: Catharine
authors.initials: C
authors.lastname: Joachim
authors.forename: Carolyn
authors.initials: C
authors.lastname: Sloan
authors.forename: Sharon
authors.initials: S
authors.lastname: Christie
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Agacinski
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Bridges
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Wilcock
authors.forename: A David
authors.initials: AD
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D000544:Alzheimer Disease / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests