Year: 2011
Type: article
Abstract: The magnitude of the effect of cerebral infarcts on dementia risk in the elderly remains controversial as is the role of microscopic infarcts on cognition. Moreover, the relationship between atherosclerosis per se and dementia is controversial. Specifically, it is unclear whether atherosclerosiscan cause the neuritic plaques and neuro fibrillary tangles that define Alzheimer neuropathology and whether atherosclerosis, a potentially reversible risk factor, can influence cognition independent of brain infarcts. We examined the relationship between macroscopic and microscopic infarcts, systemic atherosclerosis, Alzheimer type pathology and dementia in autopsies from 200 participants in the Baltimore Longitudinal Study of Aging (BLSA), a prospective study of the effect of aging on cognition, 175 of whom had complete body autopsies. Using a quantitative analysis of brain infarcts, systemicatherosclerosis, and Alzheimer type pathology, we found no relationship between the degree of systemic atherosclerosis and the degree of Alzheimer's type brain pathology. Both macroscopic and microscopic brain infarcts were important causes of dementia. Moreover, we found that the presence of intracranial but not coronary or aortic atherosclerosis significantly increased the odds of dementia, independent of cerebral infarction. Given the large number of individuals with intracranialatherosclerosis and / or brain infarcts in this cohort, the population attributable risk of dementia related to intracranial atherosclerosis and brain infarcts is substantial (rivaling the effect of AD pathology) and potentially reversible. Atherosclerosis of the intracranial arteries and cerebral infarcts are independent and important risk factors for dementia in the elderly, suggesting potentially reversible pathways, unrelated to Alzheimer's pathology, through which vascular changes may influence dementia risk.
Source: Alzheimer s & Dementia
Author: Richard O'Brien
Institution: Johns Hopkins University
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2099010970