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Effect of infarcts on dementia in the Baltimore longitudinal study of aging

Authors

  • Juan C. Troncoso MD,

    1. Department of Pathology, Johns Hopkins University, Baltimore
    2. Department of Neurology, Johns Hopkins University, Baltimore
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    • J.C.T. and A.B.Z. contributed equally to this work.

  • Alan B. Zonderman PhD,

    1. National Institute on Aging, Intramural Research Program, Laboratory of Personality and Cognition, National Institutes of Health, Bethesda
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    • J.C.T. and A.B.Z. contributed equally to this work.

  • Susan M. Resnick PhD,

    1. National Institute on Aging, Intramural Research Program, Laboratory of Personality and Cognition, National Institutes of Health, Bethesda
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  • Barbara Crain MD, PhD,

    1. Department of Pathology, Johns Hopkins University, Baltimore
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  • Olga Pletnikova BA,

    1. Department of Pathology, Johns Hopkins University, Baltimore
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  • Richard J. O'Brien MD, PhD

    Corresponding author
    1. Departments of Neurology and Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
    • Mason F Lord Center Tower, Suite 5100, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Baltimore, MD 21224
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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%.

Interpretation

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. Ann Neurol 2008

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