Schneider Julie A, Boyle Patricia A, Arvanitakis Zoe, Bienias Julia L, Bennett David A
Rush Alzheimer's Disease Center and Rush Institute for Healthy Aging, Department of Neurological Sciences, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA.
Ann Neurol. 2007 Jul;62(1):59-66. doi: 10.1002/ana.21142.
Examine the effects of subcortical infarcts with Alzheimer's disease (AD) pathology on dementia, episodic memory, and other cognitive abilities in older persons.
Participants included 148 autopsied subjects of the Rush Memory and Aging Project (mean age, 88.0 years), a longitudinal clinicopathological study. Cognition was assessed yearly with 21 neuropsychological tests. Infarcts were visualized on coronal slabs, and plaques and neurofibrillary tangles were counted and standardized to form a composite measure of AD pathology. Multiple regression analyses were used controlling for age, sex, and education.
Fifty-three (35.8%) subjects had cerebral infarcts. After accounting for AD pathology, infarcts increased the odds of dementia by 5.1-fold (95% confidence interval, 1.98-12.92) and lowered cognitive function by 0.50 standard unit (p = 0.001). After controlling for cortical infarcts and AD pathology, subcortical infarcts, present in 39 of 53 (73.6%) subjects with infarcts, increased the odds of dementia by almost 4-fold and reduced cognitive function by more than a third of a unit (parameter estimate = -0.37; p = 0.03). In analyses with cognitive abilities, subcortical infarcts were associated with lower episodic, semantic, and working memory (p < or = 0.05), and had an interaction with AD pathology to further worsen working memory (p = 0.02).
Subcortical infarcts add to deleterious effects of AD pathology by increasing the odds of dementia and lowering memory function.
研究伴有阿尔茨海默病（AD）病理改变的皮质下梗死对老年人痴呆、情景记忆及其他认知能力的影响。
研究对象包括拉什记忆与衰老项目的148名尸检受试者（平均年龄88.0岁），这是一项纵向临床病理研究。每年用21项神经心理学测试评估认知情况。在冠状切片上观察梗死灶，对斑块和神经原纤维缠结进行计数并标准化，以形成AD病理的综合测量指标。采用多元回归分析，对年龄、性别和教育程度进行控制。
53名（35.8%）受试者有脑梗死。在考虑AD病理因素后，梗死使痴呆几率增加5.1倍（95%置信区间，1.98 - 12.92），并使认知功能降低0.50个标准差单位（p = 0.001）。在控制皮质梗死和AD病理因素后，53名有梗死的受试者中有39名（73.6%）存在皮质下梗死，其使痴呆几率增加近4倍，认知功能降低超过三分之一单位（参数估计值 = -0.37；p = 0.03）。在对认知能力的分析中，皮质下梗死与情景记忆、语义记忆和工作记忆降低相关（p≤0.05），并且与AD病理存在相互作用，进一步恶化工作记忆（p = 0.02）。
皮质下梗死通过增加痴呆几率和降低记忆功能，加重了AD病理的有害影响。
