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CL Ropp 1 , SL Tyas 1 , KP Riley 2 , KS SantaCruz 3

CL Ropp 1 , SL Tyas 1 , KP Riley 2 , KS SantaCruz 3 1 University of Waterloo, 2 University of Kentucky, 3 University of Minnesota March 29, 2011. The Impact of Brain Infarcts on Dementia Varies by Apolipoprotein E and Educational Status. Brain Infarcts & Alzheimer’s Disease.

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CL Ropp 1 , SL Tyas 1 , KP Riley 2 , KS SantaCruz 3

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  1. CL Ropp1, SL Tyas1, KP Riley2, KS SantaCruz3 1University of Waterloo, 2University of Kentucky, 3University of Minnesota March 29, 2011 The Impact of Brain Infarcts on Dementia Varies by Apolipoprotein E and Educational Status

  2. Brain Infarcts &Alzheimer’s Disease • The clinical expression of Alzheimer’s disease (AD) may be influenced by the presence of brain infarcts • Not all individuals with brain infarcts, however, experience dementia

  3. Established Risk Factors for AD • Apolipoprotein E (ApoE) status • the ApoE-e4 allele • Educational level • Low educational attainment

  4. Research Aim • To examine if the influence of brain infarcts on AD and dementia varies by ApoE and educational status

  5. Methods - Sample • Data Source: The Nun Study • 678 agreed to participate • Annual cognitive and physical assessments • Access to convent archives • Brain donation after death • At the time of this study, 484 participants had died and had pathologic assessment for AD and brain infarcts

  6. Methods - Measures • Outcomes: • Dementia • CERAD battery of neuropsychological tests and impaired activities of daily living • AD Pathology • CERAD (probable/definite) or NIA-RI (intermediate/high likelihood) criteria • Alzheimer’s Disease • Both dementia and AD pathology (CERAD/NIA-RI)

  7. Methods - Measures • Exposure: • Brain infarcts • Any large or lacunar infarcts visible to the naked eye at gross pathologic assessment • Modifiers: • ApoE and educational status

  8. Methods - Analysis • Descriptive • Chi-square tests and t-tests • Multivariate • Logistic regression • Predictor: brain infarcts • Outcomes: dementia, AD (various definitions) • Adjusted by age, ApoE status, and education • Stratified by ApoE status or education

  9. Conclusions • Brain infarcts significantly increased the risk of dementia, particularly among low-risk ApoE and educational subgroups • Brain infarcts were not significantly associated with AD pathology or combined AD pathology/dementia outcome

  10. Conclusions • Impact of infarcts seems to be driven by their association with clinical symptoms of dementia rather than AD pathology • The greater predictive power of infarcts within low-risk subgroups raises questions about the interplay of neuropathology, risk factors and brain reserve

  11. Acknowledgements • School Sisters of Notre Dame religious congregation • Funding for the Nun Study at the University of Kentucky: NIA 5R01AG09862, K04AG00553, P50AG05144; and the Kleberg Foundation • Funding for this project at the University of Waterloo: Alzheimer’s Association grant NIRG 05-14562 • University of Minnesota, home of the Nun Study

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