title: Risk of incident clinical diagnosis of Alzheimer's disease-type dementia attributable to pathology-confirmed vascular disease.
abstract: BACKGROUND
  The presence of cerebrovascular pathology may increase the risk of clinical diagnosis of Alzheimer's disease (AD).
  
  
  METHODS
  We examined excess risk of incident clinical diagnosis of AD (probable and possible AD) posed by the presence of lacunes and large infarcts beyond AD pathology using data from the Statistical Modeling of Aging and Risk of Transition study, a consortium of longitudinal cohort studies with more than 2000 autopsies. We created six mutually exclusive pathology patterns combining three levels of AD pathology (low, moderate, or high AD pathology) and two levels of vascular pathology (without lacunes and large infarcts or with lacunes and/or large infarcts).
  
  
  RESULTS
  The coexistence of lacunes and large infarcts results in higher likelihood of clinical diagnosis of AD only when AD pathology burden is low.
  
  
  CONCLUSIONS
  Our results reinforce the diagnostic importance of AD pathology in clinical AD. Further harmonization of assessment approaches for vascular pathologies is required.
authors.affiliation: Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR; Michigan Alzheimer's Disease Center, Department of Neurology, University of Michigan, Ann Arbor, MI. Electronic address: dodgeh@ohsu.edu.
authors.forename: Hiroko H
authors.initials: HH
authors.lastname: Dodge
authors.affiliation: School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR.
authors.forename: Randy
authors.initials: R
authors.lastname: Woltjer
authors.affiliation: Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; Department of Pathology, University of Kentucky, Lexington, KY.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Nelson
authors.affiliation: Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL.
authors.forename: David A
authors.initials: DA
authors.lastname: Bennett
authors.affiliation: Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Cairns
authors.affiliation: Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; College of Public Health, Department of Biostatistics, University of Kentucky, Lexington, KY.
authors.forename: David W
authors.initials: DW
authors.lastname: Fardo
authors.affiliation: Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR; Portland VA Medical Center, Portland, OR.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kaye
authors.affiliation: Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR; Portland VA Medical Center, Portland, OR.
authors.forename: Deniz-Erten
authors.initials: DE
authors.lastname: Lyons
authors.affiliation: Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR.
authors.forename: Nora
authors.initials: N
authors.lastname: Mattek
authors.affiliation: Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL; Department of Pathology, Rush University Medical Center, Chicago, IL.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schneider
authors.affiliation: Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR; Portland VA Medical Center, Portland, OR.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Silbert
authors.affiliation: Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Chengjie
authors.initials: C
authors.lastname: Xiong
authors.affiliation: Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL.
authors.forename: Lei
authors.initials: L
authors.lastname: Yu
authors.affiliation: Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; College of Medicine, Departments of Neurology and Psychiatry, University of Kentucky, Lexington, KY.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Schmitt
authors.affiliation: Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; College of Public Health, Department of Biostatistics, University of Kentucky, Lexington, KY.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kryscio
authors.affiliation: Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY; College of Public Health, Department of Epidemiology, University of Kentucky, Lexington, KY.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Abner
mesh_terms: D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000473:pathology*; D001057:Apolipoproteins E / Q000235:genetics; D001921:Brain / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000235:genetics / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D012306:Risk
chemical_list: D001057:Apolipoproteins E
keywords: Alzheimer's disease pathology; Community sample; Population Attributable Risk%; SMART consortium; Vascular pathology