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Cognitive impact of subcortical vascular and Alzheimer's disease pathology.
Ann Neurol. 2006 Dec; 60(6):677-87.AN

Abstract

OBJECTIVE

To assess the interactions among three types of pathology (ie, cerebrovascular disease, hippocampal sclerosis [HS], and Alzheimer's disease [AD]), cognitive status, and apolipoprotein E genotype.

METHODS

We report clinicopathological correlations from 79 autopsy cases derived from a prospective longitudinal study of subcortical ischemic vascular disease and AD.

RESULTS

Thirty percent of the cases had significant cerebrovascular parenchymal pathology scores (CVDPS), 54% had significant AD pathology, and 18% had HS. In an ordinal logistic regression analysis that included interaction terms to assess the effects of each pathological variable when the other variables are interpolated to zero, each of the three pathology variables contributed independently to cognitive status: Braak and Braak stage odds ratio (OR) = 2.84 (95% confidence interval, 1.81-4.45), HS score OR = 2.43 (95% confidence interval, 1.01-5.85), and CVDPS OR = 1.02 (95% confidence interval, 1.00-1.04). Only Braak and Braak stage contributed to a global neuropsychological measure of cognitive impairment. Apolipoprotein E4 genotype was associated with Braak and Braak stage (OR, 1.31 [95% confidence interval, 1.03-1.68]), but not CVDPS or HS scores.

INTERPRETATION

In this convenience sample enriched for subcortical ischemic vascular disease, HS was a common unsuspected neuropathological finding. Apolipoprotein E4 genotype was associated with cerebral amyloid angiopathy, but not HS or arteriosclerosis. When Braak and Braak stage was interpolated to zero, both CVDPS and HS contributed to cognitive impairment. However, advancing stages of AD pathology overwhelmed the effects of CVDPS and HS, to become the major determinant of dementia.

Authors+Show Affiliations

Department of Neurology, University of Southern California, Los Angeles, USA. chui@usc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17192928

Citation

Chui, Helena C., et al. "Cognitive Impact of Subcortical Vascular and Alzheimer's Disease Pathology." Annals of Neurology, vol. 60, no. 6, 2006, pp. 677-87.
Chui HC, Zarow C, Mack WJ, et al. Cognitive impact of subcortical vascular and Alzheimer's disease pathology. Ann Neurol. 2006;60(6):677-87.
Chui, H. C., Zarow, C., Mack, W. J., Ellis, W. G., Zheng, L., Jagust, W. J., Mungas, D., Reed, B. R., Kramer, J. H., Decarli, C. C., Weiner, M. W., & Vinters, H. V. (2006). Cognitive impact of subcortical vascular and Alzheimer's disease pathology. Annals of Neurology, 60(6), 677-87.
Chui HC, et al. Cognitive Impact of Subcortical Vascular and Alzheimer's Disease Pathology. Ann Neurol. 2006;60(6):677-87. PubMed PMID: 17192928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cognitive impact of subcortical vascular and Alzheimer's disease pathology. AU - Chui,Helena C, AU - Zarow,Chris, AU - Mack,Wendy J, AU - Ellis,William G, AU - Zheng,Ling, AU - Jagust,William J, AU - Mungas,Dan, AU - Reed,Bruce R, AU - Kramer,Joel H, AU - Decarli,Charles C, AU - Weiner,Michael W, AU - Vinters,Harry V, PY - 2006/12/29/pubmed PY - 2007/2/27/medline PY - 2006/12/29/entrez SP - 677 EP - 87 JF - Annals of neurology JO - Ann. Neurol. VL - 60 IS - 6 N2 - OBJECTIVE: To assess the interactions among three types of pathology (ie, cerebrovascular disease, hippocampal sclerosis [HS], and Alzheimer's disease [AD]), cognitive status, and apolipoprotein E genotype. METHODS: We report clinicopathological correlations from 79 autopsy cases derived from a prospective longitudinal study of subcortical ischemic vascular disease and AD. RESULTS: Thirty percent of the cases had significant cerebrovascular parenchymal pathology scores (CVDPS), 54% had significant AD pathology, and 18% had HS. In an ordinal logistic regression analysis that included interaction terms to assess the effects of each pathological variable when the other variables are interpolated to zero, each of the three pathology variables contributed independently to cognitive status: Braak and Braak stage odds ratio (OR) = 2.84 (95% confidence interval, 1.81-4.45), HS score OR = 2.43 (95% confidence interval, 1.01-5.85), and CVDPS OR = 1.02 (95% confidence interval, 1.00-1.04). Only Braak and Braak stage contributed to a global neuropsychological measure of cognitive impairment. Apolipoprotein E4 genotype was associated with Braak and Braak stage (OR, 1.31 [95% confidence interval, 1.03-1.68]), but not CVDPS or HS scores. INTERPRETATION: In this convenience sample enriched for subcortical ischemic vascular disease, HS was a common unsuspected neuropathological finding. Apolipoprotein E4 genotype was associated with cerebral amyloid angiopathy, but not HS or arteriosclerosis. When Braak and Braak stage was interpolated to zero, both CVDPS and HS contributed to cognitive impairment. However, advancing stages of AD pathology overwhelmed the effects of CVDPS and HS, to become the major determinant of dementia. SN - 0364-5134 UR - https://www.unboundmedicine.com/medline/citation/17192928/Cognitive_impact_of_subcortical_vascular_and_Alzheimer's_disease_pathology_ L2 - https://doi.org/10.1002/ana.21009 DB - PRIME DP - Unbound Medicine ER -