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 2 Subcortical Ischemic Vascular Dementia (SIVD) Neuropathology study: imaging and clinical correlations

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

Autopsy study	N/pathological diagnosis	Mean age (years)	Diagnosis of AD	Diagnosis of VBI	Prevalence of mixed	Neuropsychology	Interaction between VBI and AD on risk of dementia
Subcortical Ischemic Vascular Dementia (SIVD) study [18]	N = 61	78 (at time of neuropsych)	CERAD	CVD-PS		Linear composite measures	AD patient scores were lower than EXEC by nearly a standard deviation on average. VBI patients were rather equally impaired on EXEC,MEM and NVMEM
	AD = 23		Braak and Braak ≥ IV	Infarct score ≥20		Linear composite measures
	VBI = 11					GLOB
	Mixed = 9					MEM
	NSP = 19					EXEC
SIVD study [19]	N = 79	82.8 ± 7.0	NINDS-ADRDA criteria	ADDTC criteria	Clin Dx = 28%		Positive likelihood ratios: AD = 6.4 > VCI = 3.7 > mixed = 2.3
	AD = 34	At time of death	NINDS-ADRDA criteria	ADDTC criteria	Clin Dx = 28%
	VBI = 15		CERAD	CVD-PS	Path Dx = 11%	Cognitive status (CN, CIND, Dem)	AD pathology and hippocampal sclerosis have relatively greater effect on cognition than VBI
	Mix = 9		Braak and Braak ≥ IV	Infarct score ≥20
	NSP = 21		Braak and Braak ≥ IV	Infarct score ≥20
SIVD study [20]	N = 93	84	Lacunes associated with WMH
	Normal = 12		AD, atherosclerosis, and VBI contribute independently to cortical gray matter atrophy
	AD = 46		AD and hippocampal sclerosis are associated with hippocampal atrophy
	VBI = 14
	Mixed = 9
	NSP = 12
SIVD study [21]	N = 163	84	Cerebral atherosclerosis was positively associated with microinfarcts (OR, 2.3; 95% CI, 1.2-4.4) and cystic infarcts (OR, 2.0; 95% CI, 1.0-4.2) but not AD pathology
	Normal = 23
	AD = 81		Cerebral amyloid angiopathy was inversely associated with lacunar infarcts (OR, 0.6; 95% CI, 0.41-1.1), but positively associated with Braak and Braak stage (OR, 1.5; 95% CI, 1.1-2.1) and Consortium to Establish a Registry for Alzheimer Disease plaque score (OR, 1.5; 95% CI, 1.1-2.2)
	VBI = 21
	Mixed = 15
	NSP = 23
SIVD study (Zheng et al., manuscript submitted for publication)	N = 116	84	Pathological measures of AD, atherosclerosis, and VBI contribute independently to MRI cortical gray matter atrophy and cognitive impairment. Path analyses show that the adverse effects of atherosclerosis on cognition are largely mediated through subcortical infarcts to brain atrophy, while the effects of AD on cognition work equally through cortical atrophy as well as through a yet unmeasured direct pathway
	Normal = 12
	AD = 53
	VBI = 18
	Mixed = 9
	NSP = 24

AD, Alzheimer disease; ADDTC, Alzheimer’s Disease Diagnostic and Treatment Centers; CERAD, Consortium to Establish a Registry for Alzheimer Disease; CI, confidence interval; CIND, Cognitive impairment not meeting criteria for dementia; Clin Dx, clinical diagnosis; CN, cognitively normal; CVD-PS, cerebrovascular disease-parenchymal score; Dem, dementia; EXEC, executive score; GLOB, global cognition score; MEM, memory score; NINDS-ADRDA, National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l’Enseignement en Neurosciences; NSP, non-significant pathology; NVMEM, non-verbal memory; OR, odds ratio; Path Dx, pathological diagnosis; VBI, vascular brain injury; WMH, white matter hyperintensity.

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ISSN: 1758-9193

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