Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension

John M Olichney, L. A. Hansen, C. R. Hofstetter, M. Grundman, R. Katzman, L. J. Thal

Research output: Contribution to journalArticle

184 Citations (Scopus)

Abstract

Objective: To determine if severe cerebral amyloid angiopathy (AA) in patients with Alzheimer's disease (AD) is associated with an increased prevalence of cerebral infarction diagnosed at autopsy. Amyloid angiopathy is increasingly recognized as a cause of ischemic infarcts, as well as cerebral hemorrhages. However, the relationship of AA to cerebral infarction in patients with AD is uncertain. Design: Retrospective clinicopathological study of autopsy-confirmed cases of AD. Patients: One hundred forty-five deceased patients with AD confirmed at autopsy. Main Outcome Measures: Semiquantitative scores of AA severity were done in four brain regions: midfrontal, inferior parietal, superior temporal, and hippocampal. The finding of cerebral infarction at autopsy was modeled as a function of AA severity, hypertension, age at death, AD severity, and sex in χ2 and multiple logistic regression analyses. Results: Severe AA was significantly associated with cerebral infarction at autopsy in patients with AD (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.4 to 8.9). None of the other independent variables in the multiple logistic regression analysis were significant predictors. While hypertension was equally common in the severe and mild AA subgroups, the combination of both severe AA and hypertension interacted to increase the risk of infarction (OR, 14.2; 95% CI, 3.2 to 63.4) beyond that observed with hypertension (OR, 1.1; 95% CI, 0.4 to 3.2) or severe AA (OR, 1.3; 95% CI, 0.3 to 5.3) alone. Conclusions: Severe AA is associated with an increased frequency of cerebral infarction in patients with AD. This appears to be largely due to an interaction between severe AA and hypertension that may produce multiplicative injuries on the vasculature. Further study with regard as to how AA may cause ischemia and its role in the neuropathologic and clinical progression of AD is needed.

Original languageEnglish (US)
Pages (from-to)702-708
Number of pages7
JournalArchives of Neurology
Volume52
Issue number7
StatePublished - 1995
Externally publishedYes

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Cerebral Infarction
Alzheimer Disease
Hypertension
Autopsy
Odds Ratio
Confidence Intervals
Amyloid angiopathy
Alzheimer's Disease
Logistic Models
Regression Analysis
Cerebral Amyloid Angiopathy
Cerebral Hemorrhage
Infarction
Confidence Interval
Ischemia
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Olichney, J. M., Hansen, L. A., Hofstetter, C. R., Grundman, M., Katzman, R., & Thal, L. J. (1995). Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension. Archives of Neurology, 52(7), 702-708.

Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension. / Olichney, John M; Hansen, L. A.; Hofstetter, C. R.; Grundman, M.; Katzman, R.; Thal, L. J.

In: Archives of Neurology, Vol. 52, No. 7, 1995, p. 702-708.

Research output: Contribution to journalArticle

Olichney, JM, Hansen, LA, Hofstetter, CR, Grundman, M, Katzman, R & Thal, LJ 1995, 'Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension', Archives of Neurology, vol. 52, no. 7, pp. 702-708.
Olichney, John M ; Hansen, L. A. ; Hofstetter, C. R. ; Grundman, M. ; Katzman, R. ; Thal, L. J. / Cerebral infarction in Alzheimer's disease is associated with severe amyloid angiopathy and hypertension. In: Archives of Neurology. 1995 ; Vol. 52, No. 7. pp. 702-708.
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abstract = "Objective: To determine if severe cerebral amyloid angiopathy (AA) in patients with Alzheimer's disease (AD) is associated with an increased prevalence of cerebral infarction diagnosed at autopsy. Amyloid angiopathy is increasingly recognized as a cause of ischemic infarcts, as well as cerebral hemorrhages. However, the relationship of AA to cerebral infarction in patients with AD is uncertain. Design: Retrospective clinicopathological study of autopsy-confirmed cases of AD. Patients: One hundred forty-five deceased patients with AD confirmed at autopsy. Main Outcome Measures: Semiquantitative scores of AA severity were done in four brain regions: midfrontal, inferior parietal, superior temporal, and hippocampal. The finding of cerebral infarction at autopsy was modeled as a function of AA severity, hypertension, age at death, AD severity, and sex in χ2 and multiple logistic regression analyses. Results: Severe AA was significantly associated with cerebral infarction at autopsy in patients with AD (odds ratio [OR], 3.5; 95{\%} confidence interval [CI], 1.4 to 8.9). None of the other independent variables in the multiple logistic regression analysis were significant predictors. While hypertension was equally common in the severe and mild AA subgroups, the combination of both severe AA and hypertension interacted to increase the risk of infarction (OR, 14.2; 95{\%} CI, 3.2 to 63.4) beyond that observed with hypertension (OR, 1.1; 95{\%} CI, 0.4 to 3.2) or severe AA (OR, 1.3; 95{\%} CI, 0.3 to 5.3) alone. Conclusions: Severe AA is associated with an increased frequency of cerebral infarction in patients with AD. This appears to be largely due to an interaction between severe AA and hypertension that may produce multiplicative injuries on the vasculature. Further study with regard as to how AA may cause ischemia and its role in the neuropathologic and clinical progression of AD is needed.",
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