Clinical and imaging features of mixed Alzheimer and vascular pathologies

Chui, Helena C; Ramirez-Gomez, Liliana

doi:10.1186/s13195-015-0104-7

Alzheimer's Research & Therapy

Table 1 Community-based, autopsy studies are required to estimate the prevalence and incidence of mixed Alzheimer disease/vascular brain injury

From: Clinical and imaging features of mixed Alzheimer and vascular pathologies

Autopsy study	N	Mean age (years)	Diagnosis of AD	Diagnosis of VBI or VCI	Prevalence of mixed	Interaction between VBI and AD on risk of dementia	Neuropsychology
Nun Study [7]	102	87 (76-100)	Khachaturian plaque criteria	Number of infarcts > or <1.5 cm	39% (24/61) of dementia cases were mixed	Number of tangles and number of lacunes exert independent additive effect on MMSE and likelihood of dementia	MMSE
Nun Study [7]	102	87 (76-100)	Khachaturian plaque criteria	Number of infarcts > or <1.5 cm	39% (24/61) of dementia cases were mixed		CERAD
ROS [8,9]	550	87	Mean number of neurofibrillary tangles, neuritic plaques, and diffuse plaques in five lobes	Number of macroscopic and microscopic infarcts	28% of dementia cases were mixed	AD and VBI pathology have additive effect on odds of dementia
MAP [8,9]	425	87	Mean number of neurofibrillary tangles, neuritic plaques, and diffuse plaques in five lobes	Number of macroscopic and microscopic infarcts	44% of dementia cases were mixed
BLSA [10]	179	87.6 ± 7.1	CERAD	Macroscopic infarcts	Hemispheral infarcts alone or with AD account for 35% of dementia cases	In subjects with intermediate AD pathology scores, a single macroscopic hemispheral infarct was sufficient to cause dementia	Blessed Memory Information Concentration Test
BLSA [10]	179		Braak and Braak stage	Microscopic infarcts
BLSA [11]	200			Atherosclerosis (0-3) of coronary, aorta, and intracranial vessels	45% have remote infarct	68% of cases have atherosclerosis, which increased the odds of dementia independent of AD pathology or cerebral infarcts
BLSA [11]	175 complete autopsies, including heart and aorta				45% have remote infarct
MRC CFAS [12]	N = 456	87 (SD = 7): range 66 to 100 (63% ≥85)	CERAD scale (0-3)	Regional infarcts (>1 cm)		Association between AD pathology and cognitive status goes down with age	MMSE
	243 dementia		Diffuse plaques, neuritic plaques, tangles, atrophy	Regional infarcts (>1 cm)			AGECAT
	183 without dementia			Small vessel disease: lacunes, microinfarcts, white matter change
	183 without dementia					Association between atrophy and age continues to go up
	30 unknown					Association between atrophy and age continues to go up
MRC CFAS [13]				Self-reported vascular risk factors		Vascular risk factors were not associated with an increased burden of AD pathology at death in old age
MRC CFAS [13]				26% of non dementia cases had CVA; 43% of dementia cases had CVA
CC75 + C [14]	224	91	CERAD		22% of 113 dementia cases
Hisayama [15]	N = 469		CERAD	NINDS-AIREN	4.7% of dementia cases were mixed
	275 incident dementia cases		NIA-Reagan
	(164 autopsies)		NIA-Reagan
HAAS [16]	N = 443	86 ± 5.2	Mean number of neurofibrillary tangles and neuritic plaques over 20 fields in 4 lobes	High correlations noted between MBIs and lacunar infarcts (Spearman r = 0.45, P < 0.0001)	14.2% of dementia cases were mixed	No correlation between AD and microvascular lesions	CASI
HAAS [16]	N = 443	(72-90+)				No correlation between AD and microvascular lesions
HAAS [17]	N = 436			Number of infarcts > or <1.0 cm, microinfarcts		MBI found in 72% of demented and 61% of non-demented
	144 with dementia					MBI found in 72% of demented and 61% of non-demented
	292 without dementia					MBI and AD exert independent additive effects on cognition

AD, Alzheimer disease; AGECAT, Automated Geriatric Examination for Computer Assisted Taxonomy; BLSA, Baltimore Longitudinal Aging Study; CASI, Cognitive Abilities Screening Instrument; CC75 + C, Cambridge City Over-75 s Cohort; CERAD, Consortium to Establish a Registry for Alzheimer Disease; CFAS, Cognitive Function and Ageing Study; CVA, cerebrovascular accident; HAAS, Honolulu Asia Aging Study; MAP, Rush Memory and Aging Project; MBI, microscopic brain infarct; MMSE, Mini-Mental State Exam; MRC, Medical Research Council; NIA, National Institute on Aging; NINDS-AIREN, National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l’Enseignement en Neurosciences; ROS, Rush Religious Order Study; SD, standard deviation; VBI, vascular brain injury; VCI, vascular cognitive impairment.

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ISSN: 1758-9193

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