Abstract
INTRODUCTION
Dementia often involves comorbid Alzheimer’s and vascular pathology, but their combined impact warrants additional study.
METHODS
We analyzed the Systolic Blood Pressure Intervention Trial and categorized white matter hyperintensity (WMH) volume into highest versus lowest/mid tertile and the amyloid beta (Aβ)42/40 ratio into lowest versus mid/highest ratio tertile. Using these binary variables, we created four exposure categories: (1) combined low risk, (2) Aβ risk, (3) WMH risk, and (4) combined high risk.
RESULTS
In the cohort of 467 participants (mean age 69.7 ± 7.1, 41.8% female, 31.9% nonwhite or Hispanic) during 4.8 years of follow-up and across the four exposure categories the rates of cognitive impairment were 5.3%, 7.8%, 11.8%, and 22.6%. Compared to the combined low-risk category, the adjusted hazard ratio for cognitive impairment was 4.12 (95% confidence interval, 1.71 to 9.94) in the combined high-risk category.
DISCUSSION
This study emphasizes the potential impact of therapeutic approaches to dementia prevention that target both vascular and amyloid pathology.
Highlights
White matter hyperintensity (WMH) and plasma amyloid (Aβ42/40) are additive risk factors for the development of cognitive impairment in the SPRINT MIND trial.
Individuals in the high-risk categories of both WMH and Aβ42/40 had a near fivefold increase in risk of cognitive impairment during 4.8 years of follow-up on average.
These findings suggest that treatment strategies targeting both vascular health and amyloid burden warrant further research.
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This post is Copyright: Adam de Havenon,
Rebecca F. Gottesman,
Jeff D. Willamson,
Natalia Rost,
Richa Sharma,
Vivian Li,
Lauren Littig,
Eric Stulberg,
Guido J. Falcone,
Shyam Prabhakaran,
Andrea L. C. Schneider,
Kevin N. Sheth,
Nicholas M. Pajewski,
Adam M. Brickman | September 4, 2024