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From the Division of Neurology (Dr. Heyman), the Center for the Study of Aging and Human Development (Dr. Fillenbaum), Bryan Alzheimer's Disease Research Center (Dr. Welsh-Bohmer), and Division of Biostatistics (Drs. Peterson and Pieper), Duke University, Durham, NC; the Department of Pathology and Laboratory Medicine (Drs. Gearing and Mirra), VA Medical Center and Emory University, Atlanta, GA; and the Department of Psychiatry (Dr. Mohs), Mt. Sinai Medical Center, Bronx, NY.
Address correspondence and reprint requests to Dr. Albert Heyman, Duke University Medical Center, Box 3203, Durham, NC 27710.
Objective: To study the relation between cerebral infarction and clinical and neuropsychologic manifestations in patients with autopsy-proven Alzheimer's disease (AD) enrolled in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD).
Background: Prior studies report that subjects with neuropathologic evidence of AD and concomitant brain infarcts had poorer cognitive function and higher frequency of dementia than those with AD alone.
Methods: Clinical and neuropsychologic manifestations of dementia were studied in 74 subjects with neuropathologic findings of AD alone and 32 with AD and concomitant cerebral infarcts or lacunar lesions.
Results: The 32 patients with both AD and vascular lesions were significantly older at time of death (median age, 81 years) than the 74 patients with AD alone(76 years; p = 0.02). At the final follow-up visit, the severity of the dementia was greater in AD patients with vascular lesions(median Clinical Dementia Rating [CDR] = 3) than in those with AD alone (CDR= 2; p = 0.03). Patients with AD and vascular lesions performed significantly worse on verbal fluency, Boston Naming, and Mini-Mental State Examination (MMSE) tests. No differences between the groups were observed, however, in the semiquantitative measures of frequency of neuritic plaques or neurofibrillary tangles.
Conclusions: The clinical-neuropathologic correlations in CERAD patients generally confirm those in prior studies, indicating that the presence of cerebral infarction in patients with AD is associated with greater overall severity of clinical dementia and poorer performance on specific tests of language and cognitive function.
Supported by NIH grant AG06790.
Received December 31, 1997. Accepted in final form March 28, 1998.
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