@article{dc265d71c97e4493bb555a064a75edcf,
title = "Association Between Vascular Pathology and Rate of Cognitive Decline Independent of Alzheimer's Disease Pathology",
abstract = "Objectives: To examine the association between vascular pathology and rate of cognitive decline in older adults independent of Alzheimer's disease (AD) pathology. Design: Prospective cohort study. Setting: Community sample. Participants: Individuals from the Einstein Aging Study autopsy series (N = 62). Measurements: The Blessed Information-Memory-Concentration (BIMC) test was used to assess global cognitive status. AD pathology was quantified according to Braak stage (<3 vs ≥ 3). Vascular pathology was quantified using a previously reported macrovascular lesion (MVL) score. The association between vascular pathology and antemortem rates of cognitive decline adjusted for level of AD pathology was assessed using linear mixed-effects models. Results: Mean age was 81.8 at enrollment and 89.0 at death. Participants with more than two MVLs had faster cognitive decline than those with no MVLs (difference in annual rate of change in BIMC 0.74 points/yr, P =.03). Braak stage was also associated with cognitive decline (difference 0.57 points/yr, P =.03). The difference in rate of cognitive decline between those with more than two MVLs and those free of vascular lesions persisted after adjustment for AD pathology (difference in rate of change in BIMC 0.68 points/yr, P =.04). The effect of vascular pathology on cognitive decline was not significantly different according to AD pathology. Conclusion: Vascular brain pathology is associated with rate of cognitive decline after adjusting for level of AD pathology.",
keywords = "Alzheimer disease pathology, cerebrovascular disease, cognitive decline, vascular pathology",
author = "Ali Ezzati and Cuiling Wang and Lipton, {Richard B.} and Dorothea Altschul and Katz, {Mindy J.} and Dickson, {Dennis W.} and Derby, {Carol A.}",
note = "Funding Information: The authors would like to thank the EAS staff for assistance with recruitment and clinical and neuropsychological assessments. In addition, we appreciate all of the study participants who generously gave their time in support of this research. Financial Disclosure: This research was supported in part by National Institutes of Health (NIH) Grants NIA 2 P01 AG03949, NIA 1R01AG039409–01, NIA R03 AG045474, and CTSA 1UL1TR001073 from the National Center for Advancing Translational Sciences; the Leonard and Sylvia Marx Foundation; and the Czap Foundation. Conflict of Interest: Cuiling Wang receives research support from the National Institutes of Health (NIH) [P01 AG03949 (core leader), R03AG046504–01 (principal investigator), R01 AG039330–01 (investigator), R01AG036921 (investigator), R01 AG050448–01 (investigator), U01AG012535 (investigator)]. Richard Lipton receives research support from NIH [P01 AG03949 (Program Director), P01AG027734 (Project Leader), R01AG025119 (Investigator), R01AG022374–06A2 (Investigator), R01AG034119 (Investigator), R01AG12101 (Investigator), K23AG030857 (Mentor), K23NS05140901A1 (Mentor), and K23NS47256 (Mentor)], the National Headache Foundation, and the Migraine Research Fund; serves on the editorial boards of Neurology and Cephalalgia and as senior advisor to Headache; has reviewed for the National Institute on Aging (NIA) and National Institute of Neurological Disorders and Stroke; holds stock options in eNeura Therapeutics (a company without commercial products); serves as a consultant or advisory board member for or has received honoraria from Alder, Allergan, American Headache Society, Autonomic Technologies, Boston Scientific, Bristol Myers Squibb, Cognimed, Colucid, Electrocore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merck, Nautilus Neuroscience, Novartis, NuPathe, Vedanta, and Zogenix. Mindy Katz receives research support from NIH, NIA [P01 AG03949 (Investigator), R01 AG039409–01 (Investigator), and R03 AG045474 (Principal Investigator)]. Dennis Dickson receives research support from NIH (P50-AG016574, P50-NS072187, P01-AG003949) and the CurePSP Foundation. Dr. Dickson is an editorial board member of Acta Neuropathologica, Annals of Neurology, Brain, Brain Pathology, and Neuropathology and is editor in chief of the American Journal of Neurodegenerative Disease and the International Journal of Clinical and Experimental Pathology. Carol Derby receives research support from NIH [P01 AG03949 (Project Leader), 2U01AG012535 (PI), 5UL1TR001073–02 (Investigator)]. Author Contributions: Ezzati: Data analysis, interpretation of data, manuscript preparation, and intellectual contributions to content. Wang: Data analysis, interpretation of data, manuscript editing, intellectual contributions to content. Lipton: Acquisition of data, manuscript editing, intellectual contributions to content. Altschul: Interpretation of data, manuscript editing, intellectual contributions to content. Katz: Concept and design, acquisition and interpretation of data, manuscript editing, intellectual contributions to content. Dickson: Concept and design, pathologic evaluation and data acquisition, interpretation of data, manuscript editing, intellectual contributions to content. Derby: Concept and design, acquisition and interpretation of data, manuscript preparation, intellectual contributions to content, study supervision. Sponsor's Role: None. Publisher Copyright: {\textcopyright} 2017, Copyright the Authors Journal compilation {\textcopyright} 2017, The American Geriatrics Society",
year = "2017",
month = aug,
doi = "10.1111/jgs.14903",
language = "English (US)",
volume = "65",
pages = "1836--1841",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "8",
}