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Risk factors for dementia associated with multiple cerebral infarcts. A case-control analysis in predominantly
P B Gorelick1, J Brody, D Cohen
1Department of Neurological Sciences, Rush Medical College.
Insights
Cardiovascular disease risk factors like advanced age and smoking are linked to dementia from cerebral infarction. Modifying these factors may help prevent multi-infarct dementia.
Area of Science:
- Neurology
- Epidemiology
- Cardiovascular Medicine
Background:
- Dementia associated with cerebral infarction, also known as multi-infarct dementia, poses a significant public health challenge.
- Identifying modifiable risk factors is crucial for developing effective prevention strategies.
Purpose of the Study:
- To investigate the risk factors associated with dementia resulting from cerebral infarction.
- To differentiate between patients with multi-infarct dementia and those with multiple infarcts but without cognitive impairment.
Main Methods:
- A case-control study was conducted in a hospital setting.
- 61 patients with multi-infarct dementia (index cases) and 86 patients with multiple infarcts but no dementia (controls) were recruited.
- Demographic data and cardiovascular disease risk factors were collected and analyzed.
Main Results:
- Index cases were older, less educated, had lower incomes, and more frequently reported a family history of dementia and proteinuria.
- Logistic regression identified advanced age, lower educational attainment, history of myocardial infarction, and recent cigarette smoking as positively associated with dementia.
- Systolic blood pressure was negatively associated with dementia risk.
Conclusions:
- Cardiovascular disease risk factors appear to be potential modifiable predictors of dementia associated with cerebral infarction.
- Further well-designed epidemiologic studies are warranted to confirm these associations and inform public health interventions.
Objective:
To clarify risk factors for dementia associated with cerebral infarction.
Design:
Case-control study.
Setting:
The study was conducted in a hospital setting.
Patients:
The subjects were consecutive patients with acute stroke with multiple cerebral infarctions who were admitted to the hospital between November 1, 1987, and December 1, 1990. They were predominantly elderly African Americans. Index cases met criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, for multi-infarct dementia, whereas control subjects were patients with multiple infarcts who did not have dementia. There were 61 multi-infarct disease index cases and 86 controls without cognitive impairment.
Main Outcome Measures:
Demographic and cardiovascular disease risk factor variables.
Results:
Index cases were older (mean [+/- SD] age, 75.5 +/- 9.7 vs 69.6 +/- 9.1 years), were less well educated (odds ratio, 4.37; confidence interval, 2.12 to 9.04), had lower annual incomes (odds ratio, 8.82; confidence interval, 2.38 to 32.70), more frequently had a family history of dementia (odds ratio, 3.61; confidence interval, 1.09 to 11.96) and laboratory evidence of proteinuria (odds ratio, 3.66; confidence interval, 1.54 to 8.71), had lower scores on neuropsychological tests, had more neurologic signs and symptoms, and were more functionally impaired in activities of daily living. Multiple logistic regression analysis showed that advanced age, lower educational attainment, history of myocardial infarction, and recent cigarette smoking were positively associated with case status and systolic blood pressure level was negatively associated with case status.
Conclusions:
Cardiovascular disease risk factors may be modifiable predictors of dementia associated with cerebral infarction. Additional well-designed epidemiologic studies are needed to clarify these associations.