Effect of infarcts on dementia in the Baltimore longitudinal study of aging
Open accessAbstract
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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AD neuropathologic change is documented in approximately 80% of cases with a traditional clinical diagnosis of "AD dementia".
“AD neuropathologic change is documented in approximately 80% of cases with a traditional clinical diagnosis of “AD dementia” (see Fig. 5 for an example of clinical misdiagnosis of “AD dementia”) [50–52,162,185,209–211].”
From NIA‐AA Research Framework: Toward a biological definition of Alzheimer's disease (2018) · cites this paper as [210]
The Subjects and Methods sections describe clinical dementia diagnoses and grading of AD pathology, but do not report the proportion of clinically diagnosed “AD dementia” cases with AD neuropathologic change. The Results report that AD pathology alone accounted for 50% of dementia cases in this cohort, a different measure from the claimed approximately 80%. Searches for clinically diagnosed AD and 80% did not find that proportion in our copy; page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measuredAD pathology alone more frequently accounts for dementia than both macroscopic and microscopic infarcts.
“However, AD pathology alone more frequently accounts for dementia than both macroscopic and microscopic infarcts [15]”
From The overlap between vascular disease and Alzheimer’s disease - lessons from pathology (2014) · cites this paper as [15]
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References 45 · Cited by 219
- Authors
- Troncoso, J. C., Zonderman, A. B., Resnick, S. M., Crain, B., Pletnikova, O., & O'Brien, R. J.
- Affiliations
- Johns Hopkins University (US)
- National Institutes of Health (US)
- Venue
- Annals of Neurology
- Publisher
- Wiley
- Published
- 2008-05-21
- Volume
- 64
- Issue
- 2
- Pages
- 168-176
- ISSN
- 0364-5134 (ISSN-L)
- 1531-8249
- PMC
- PMC2694129
- OpenAlex
- W2082848858
- Cited by
- 219
- References
- 45
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 7 · 2023: 9 · 2022: 6 · 2021: 6 · 2020: 8 · 2019: 10 · 2018: 16 · 2017: 13 · 2016: 18 · 2015: 19 · 2014: 13 · 2013: 17 · 2012: 21
- FWCI
- 10.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute on Aging (Z01AG000185, P50AG005146, P50AG05146)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- cerebral infarction, dementia, Alzheimer's disease pathology, cerebrovascular disease, stroke risk factors, cognitive decline, postmortem brain examination, Baltimore Longitudinal Study of Aging
- MeSH terms
- Aged, Aged, 80 and over, Aging, Alzheimer Disease, Cerebral Infarction, Dementia, Female, Humans, Longitudinal Studies, Male, Prospective Studies, Risk Factors, Baltimore, Cohort Studies
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