Risk factors for dementia associated with multiple cerebral infarcts. A case-control analysis in predominantly African-American hospital-based patients
P. B. Gorelick, J. Brody, D. Cohen, S. Freels, P. Levy, W. Dollear, H. Forman and Y. Harris
Department of Neurological Sciences, Rush Medical College.
OBJECTIVE--To clarify risk factors for dementia associated with cerebral
infarction. DESIGN--Case-control study. SETTING--The study was conducted in
a hospital setting. PATIENTS--The subjects were consecutive patients with
acute stroke with multiple cerebral infarctions who were admitted to the
hospital between November 1, 1987, and December 1, 1990. They were
predominantly elderly African Americans. Index cases met criteria of the
Diagnostic and Statistical Manual of Mental Disorders, Third Edition, for
multi-infarct dementia, whereas control subjects were patients with
multiple infarcts who did not have dementia. There were 61 multi-infarct
disease index cases and 86 controls without cognitive impairment. MAIN
OUTCOME MEASURES--Demographic and cardiovascular disease risk factor
variables. RESULTS--Index cases were older (mean [+/- SD] age, 75.5 +/- 9.7
vs 69.6 +/- 9.1 years), were less well educated (odds ratio, 4.37;
confidence interval, 2.12 to 9.04), had lower annual incomes (odds ratio,
8.82; confidence interval, 2.38 to 32.70), more frequently had a family
history of dementia (odds ratio, 3.61; confidence interval, 1.09 to 11.96)
and laboratory evidence of proteinuria (odds ratio, 3.66; confidence
interval, 1.54 to 8.71), had lower scores on neuropsychological tests, had
more neurologic signs and symptoms, and were more functionally impaired in
activities of daily living. Multiple logistic regression analysis showed
that advanced age, lower educational attainment, history of myocardial
infarction, and recent cigarette smoking were positively associated with
case status and systolic blood pressure level was negatively associated
with case status. CONCLUSIONS--Cardiovascular disease risk factors may be
modifiable predictors of dementia associated with cerebral infarction.
Additional well-designed epidemiologic studies are needed to clarify these
associations.
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