Kapasi Alifiya, Capuano Ana W, Mojdeganlou Paniz, Bennett David A, Lamar Melissa, Leurgans Sue E, Schneider Julie A, Barnes Lisa L
Rush Alzheimer's Disease Center (A.K., A.W.C., P.M., D.A.B., M.L., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL.
Department of Pathology (A.K., J.A.S.), Rush University Medical Center, Chicago, IL.
Stroke. 2025 Apr 28. doi: 10.1161/STROKEAHA.124.047954.
Few neuropathologic studies focus on the associations of cerebrovascular pathologies with cognition in older Black adults.
We conducted a nested substudy of participants who were enrolled in 1 of 4 harmonized longitudinal cohort studies-the Minority Aging Research Study, African American Clinical Core, Rush Memory and Aging Project, and Religious Order Study before coming to autopsy. Neuropathologic evaluation included assessment of cerebrovascular and neurodegenerative pathologies. We first documented single and mixed cerebrovascular profiles and neurodegenerative pathologies in 112 Black decedents and examined the pathological burden with cognitive function proximate to death. In secondary analyses, we matched 2:1 the 112 Black decedents to 214 White decedents from the same cohorts using Mahalanobis distance matching and conducted linear regression models to examine racial differences in the burden of each vascular pathology and their associations with cognition.
In older Black decedents, macroscopic infarcts were present in 37%, microinfarcts in 30%, basal ganglia arteriolosclerosis in 20%, cerebral amyloid angiopathy in 32%, and atherosclerosis in 14%. Single cerebrovascular profiles were present in 29% and mixed cerebrovascular profiles in 40%. Microinfarcts (estimate=-0.51, SE=0.23, =0.03) and arteriolosclerosis in the basal ganglia (estimate =-0.29, SE=0.13, =0.03) were associated with lower global cognition independent of neurodegenerative pathologies. Further, microinfarcts were associated with lower episodic and semantic memory, and perceptual speed, whereas arteriolosclerosis was associated with only semantic memory. Mixed vascular profiles were also associated with lower episodic memory and perceptual speed. In secondary analyses, the burden of cerebrovascular pathologies and cognitive associations were similar across races.
Cerebrovascular pathologies are common in older Black decedents, most often as a mixed cerebrovascular pathology profile. Arteriosclerosis and microinfarcts were associated with lower cognition above and beyond the presence of neurodegenerative pathologies. Burden and cognitive associations with cerebrovascular pathologies were similar across races.
很少有神经病理学研究关注老年黑人脑血管病变与认知之间的关联。
我们对参加了4项协调的纵向队列研究（少数族裔衰老研究、非裔美国人临床核心研究、拉什记忆与衰老项目以及宗教团体研究）之一且后来接受尸检的参与者进行了一项嵌套子研究。神经病理学评估包括对脑血管和神经退行性病变的评估。我们首先记录了112名黑人死者的单一和混合脑血管特征以及神经退行性病变，并检查了临近死亡时病理负担与认知功能的关系。在二次分析中，我们使用马氏距离匹配将112名黑人死者与来自同一队列的214名白人死者按2:1进行匹配，并进行线性回归模型以检查每种血管病变负担的种族差异及其与认知的关联。
在老年黑人死者中，37%存在宏观梗死，30%存在微梗死，20%存在基底节小动脉硬化，32%存在脑淀粉样血管病，14%存在动脉粥样硬化。单一脑血管特征占29%，混合脑血管特征占40%。微梗死（估计值=-0.51，标准误=0.23，P=0.03）和基底节小动脉硬化（估计值=-0.29，标准误=0.13，P=0.03）与较低的整体认知相关，且独立于神经退行性病变。此外，微梗死与较低的情景记忆和语义记忆以及知觉速度相关，而小动脉硬化仅与语义记忆相关。混合血管特征也与较低的情景记忆和知觉速度相关。在二次分析中，不同种族的脑血管病变负担和认知关联相似。
脑血管病变在老年黑人死者中很常见，最常见的是混合脑血管病变特征。动脉硬化和微梗死与神经退行性病变之外的较低认知相关。不同种族的脑血管病变负担和认知关联相似。
