Schneider J A, Wilson R S, Bienias J L, Evans D A, Bennett D A
Rush Alzheimer's Disease Center and Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL 60612, USA.
Neurology. 2004 Apr 13;62(7):1148-55. doi: 10.1212/01.wnl.0000118211.78503.f5.
Alzheimer disease (AD) is the most common cause of dementia. The effect of cerebral infarctions on the likelihood of dementia from AD pathology is not well understood.
The study included 153 deceased Catholic clergy who participated in the Religious Orders Study. Annual evaluations, including 19 tests of cognitive function, were performed to determine a diagnosis of dementia and level of cognitive abilities proximate to death. At autopsy, neuritic and diffuse plaques and neurofibrillary tangles were counted and combined into a standardized summary measure of AD pathology. Number, volume, side, and distribution of old macroscopic infarctions were recorded. Analyses included logistic and linear regression, adjusting for age, sex, and education.
The AD pathology score ranged from 0 to 2.93 units, and 54 persons had infarctions. There was no relationship between AD pathology and infarctions (r = 0.04, p = 0.56). Each unit of AD pathology increased the odds of dementia by 4.40-fold (95% CI = 2.33 to 8.32), and this was essentially unchanged after accounting for infarctions. The presence of one or more infarctions independently increased the odds of dementia by 2.80-fold (95% CI = 1.26 to 6.21). There was no interaction between AD pathology and infarctions to further increase the likelihood of dementia (p = 0.39). The number, size, and distribution of infarctions added to the odds of dementia but also did not show an interaction with AD pathology. Similar results were found in analyses with global cognitive function and five different cognitive systems.
Cerebral infarctions independently contribute to the likelihood of dementia but do not interact with AD pathology to increase the likelihood of dementia beyond their additive effect.
阿尔茨海默病（AD）是痴呆最常见的病因。脑梗死对AD病理所致痴呆可能性的影响尚不清楚。
该研究纳入了153名参与宗教团体研究的已故天主教神职人员。进行年度评估，包括19项认知功能测试，以确定痴呆诊断及死亡时的认知能力水平。尸检时，对神经炎斑、弥漫性斑块和神经原纤维缠结进行计数，并合并为AD病理的标准化综合指标。记录陈旧性宏观梗死灶的数量、体积、部位和分布。分析包括逻辑回归和线性回归，并对年龄、性别和教育程度进行校正。
AD病理评分范围为0至2.93单位，54人有梗死灶。AD病理与梗死灶之间无相关性（r = 0.04，p = 0.56）。AD病理的每个单位使痴呆的几率增加4.40倍（95%可信区间 = 2.33至8.32），在考虑梗死灶后基本不变。存在一个或多个梗死灶独立使痴呆的几率增加2.80倍（95%可信区间 = 1.26至6.21）。AD病理与梗死灶之间没有相互作用进一步增加痴呆的可能性（p = 0.39）。梗死灶的数量、大小和分布增加了痴呆的几率，但也未显示与AD病理有相互作用。在对整体认知功能和五个不同认知系统的分析中发现了类似结果。
脑梗死独立增加痴呆的可能性，但不与AD病理相互作用以增加痴呆的可能性超过其相加效应。
