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Small Concomitant Vascular Lesions Do Not Influence Rates of Cognitive Decline in Patients With Alzheimer Disease
Jae-Hong Lee, MD;
John M. Olichney, MD;
Lawrence A. Hansen, MD;
C. Richard Hofstetter, PhD;
Leon J. Thal, MD
Arch Neurol. 2000;57:1474-1479.
Objective To determine the relation between concomitant small cerebral infarction and clinical progression of Alzheimer disease (AD).
Design A retrospective clinicopathologic study of patients with AD.
Methods We searched the databases of the University of California, San Diego, Alzheimer's Disease Research Center, La Jolla, for patients with an autopsy diagnosis of definite AD with or without a concomitant small cerebral infarction. Clinical and neuropsychologic data obtained during longitudinal follow-up were available for 201 subjects with AD neuropathologic features and 36 with AD and concomitant cerebral infarcts (volume, <10 cm3). The rates of cognitive decline on the Mini-Mental State Examination and the Dementia Rating Scale were each calculated and compared between the 2 groups.
Results The age at death was significantly (P = .05) higher and the Braak stage was lower in patients with mixed AD and infarct pathological features compared with those with AD pathological features only. The rate of cognitive decline over time was not significantly (P .20 for all) different between the 2 groups. There was a trend for the presence of a cerebral infarct to be associated with more severe clinical dementia (P = .08) as measured by the Dementia Rating Scale, but no such trend for the Mini-Mental State Examination.
Conclusion This clinicopathologic correlation study suggests that concomitant small cerebral infarcts with a total volume of less than 10 cm3 do not significantly influence the overall rate of global cognitive decline in patients with AD.
From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea (Dr Lee); the Alzheimer's Disease Research Center (Drs Olichney, Hansen, Hofstetter, and Thal) and the Department of Neurosciences (Drs Olichney, Hansen, and Thal), University of California, San Diego, La Jolla; and the Neurology Service, Veterans Affairs Medical Center, San Diego, Calif (Drs Olichney and Thal).
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