Cited by 739Dementia and Cognitive Impairment ResearchNeurological Disease Mechanisms and TreatmentsAlzheimer's disease research and treatments

The DOI matches its Crossref record; 195 of the 196 references it cites were found in a registry or an index; none of the 57 sources its claims cite is checked for support yet.

The overlap between vascular disease and Alzheimer’s disease - lessons from pathology

Open access
Attems, Johannes, Jellinger, Kurt A·2014·BMC Medicine

Abstract

Recent epidemiological and clinico-pathological data indicate considerable overlap between cerebrovascular disease (CVD) and Alzheimer's disease (AD) and suggest additive or synergistic effects of both pathologies on cognitive decline. The most frequent vascular pathologies in the aging brain and in AD are cerebral amyloid angiopathy and small vessel disease. Up to 84% of aged subjects show morphological substrates of CVD in addition to AD pathology. AD brains with minor CVD, similar to pure vascular dementia, show subcortical vascular lesions in about two-thirds, while in mixed type dementia (AD plus vascular dementia), multiple larger infarcts are more frequent. Small infarcts in patients with full-blown AD have no impact on cognitive decline but are overwhelmed by the severity of Alzheimer pathology, while in early stages of AD, cerebrovascular lesions may influence and promote cognitive impairment, lowering the threshold for clinically overt dementia. Further studies are warranted to elucidate the many hitherto unanswered questions regarding the overlap between CVD and AD as well as the impact of both CVD and AD pathologies on the development and progression of dementia.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes pathological and clinicopathological evidence that cerebrovascular disease (CVD) and Alzheimer’s disease (AD) frequently overlap, with additive or synergistic effects on cognitive decline. It emphasizes that vascular lesions may lower the threshold for dementia in early AD, while severe AD pathology often overwhelms the cognitive impact of small vascular lesions.

Key findings

  • Up to 84% of aged subjects show morphological substrates of CVD in addition to AD pathology; cerebral amyloid angiopathy (CAA) is present in 82% to 98% of AD patients, and small vessel disease (SVD) is common in both aging and AD.
  • In pure vascular dementia (VaD), about 68% of cases show lacunar/strategic subcortical infarcts and 32.5% show multiple large cortico-subcortical infarcts; in mixed dementia (AD + severe CVD), 56.6% show multiple large/lobar or cortico-subcortical lesions and 43.4% show small subcortical lacunar, micro-infarcts, or strategic infarcts.
  • Small infarcts in full-blown AD have no impact on cognitive decline and are overwhelmed by Alzheimer pathology, whereas in early AD, cerebrovascular lesions may promote cognitive impairment and lower the threshold for clinically overt dementia.
  • Converging autopsy, amyloid PET, functional MRI, and CSF biomarker evidence indicates that AD and CVD exert additive rather than interactive adverse effects on cognitive health, though interactions between vascular factors and amyloidosis/tauopathy remain unresolved.

Methods

  • Narrative review of epidemiological, clinico-pathological, and autopsy studies on the overlap between CVD and AD, including data from large cohorts such as the National Alzheimer’s Coordinating Center (NACC) database and the Rush Memory and Aging Project/Religious Orders Study.
  • The paper summarizes prevalence and topographical distribution of cerebrovascular lesions across AD, VaD, mixed dementia, and aged controls, using tables from prior autopsy series (e.g., VaD total 188; mixed dementia n = 83; NACC 5,715 autopsy cases).
  • Main analysis is qualitative synthesis of reported frequencies, odds ratios, and clinicopathological correlations; no new primary data or systematic meta-analysis are presented.

Limitations

  • The paper states that further studies are warranted to elucidate unanswered questions about CVD–AD overlap and that there is still a lack of consensus on incorporating vascular disease into clinical and neuropathological classification schemes for dementias.
  • It notes that sample selection may strongly bias results: community samples tend to show greater cerebrovascular pathology than hospital-based samples, and mixed AD/CVD prevalence was higher in the community-based RUSH Memory and Aging Project (44%) than in the RUSH Religious Order Study (28%).
  • The text also raises doubts about PiB-PET as representative of Aβ loads in the living brain and states that differentiation of mixed AD/CVD with CSF biomarkers may be difficult; evident from the text, this is a narrative review without a systematic search or quantitative pooling, so findings depend on heterogeneous autopsy cohorts and diagnostic criteria.

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Integrity signals

Registry

Crossref · 10.1186/s12916-014-0206-2

Cites

195 of 195 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 Pathogenic factors for the development of mixed dementia. Modified from [147].
Figure 1 Pathogenic factors for the development of mixed dementia. Modified from [147].CC BY · PubMed Central

Verification

Claims the paper makes

51 Not checked yet · 12 Own interpretation · 6 No basis given · 1 Own result

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  • It may state two separate claims as one. 7
  • Probably not a substantial claim. 1
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  • The authors state this as an assumption.

    WMLs contribute to cognitive decline.

    “and, thus, are assumed to contribute to cognitive decline [184].”
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Citations

Cites

Show all 196 references

Research works printed but not linked: 2

  1. Crystal H, Dickson D: Cerebral infarcts in patients with autopsy proven Alzheimer’s disease. Neurobiol Aging. 2002, 23: 207.
  2. Jentoft M, Parisi J, Dickson D, Johnson K, Boeve B, Knopman D, Petersen R: Neuropathologic findings in 32 nondemented elderly subjects (abs.). J Neuropathol Exp Neurol. 2011, 70: 531.

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Metadata

Authors
Attems, J., & Jellinger, K. A.
Affiliations
  • Newcastle University (GB)
  • Medical University of Vienna (AT)
Corresponding author
Attems, Johannes
Venue
BMC Medicine
Published
2014-11-11
Volume
12
Issue
1
Pages
206-206
ISSN
1741-7015 (ISSN-L)
OpenAlex
W2043522411
Cited by
739
References
196
Citations by year
2026: 55 · 2025: 79 · 2024: 73 · 2023: 66 · 2022: 61 · 2021: 71 · 2020: 91 · 2019: 70 · 2018: 53 · 2017: 44 · 2016: 53 · 2015: 19 · 2014: 3
FWCI
5.49
Type
journal article
Language
en
Open access
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by)
Funders
  • Alzheimer's Society
  • National Institute for Health and Care Research
  • Dunhill Medical Trust (R173/1110)
  • Newcastle University (G0400074)
  • Newcastle upon Tyne Hospitals NHS Foundation Trust
  • Medical Research Council (G0400074)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
Keywords
Alzheimer's disease, cerebrovascular disease, cerebral amyloid angiopathy, cerebral small vessel disease, vascular dementia, mixed dementia, cognitive decline, dementia progression, subcortical infarcts
MeSH terms
Aging, Alzheimer Disease, Cerebrovascular Disorders, Humans

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