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July 1993

Risk Factors for Dementia Associated With Multiple Cerebral Infarcts: A Case-Control Analysis in Predominantly African-American Hospital-Based Patients

Author Affiliations

From the Department of Neurological Sciences, Rush Medical College (Dr Gorelick and Mss Dollear and Harris), School of Public Health, Epidemiology and Biometry Program and Gerontology Center, University of Illinois at Chicago (Drs Gorelick, Brody, Cohen, Freels, and Levy), and Department of Psychiatry, Michael Reese Hospital and Medical Center (Dr Forman), Chicago.

Arch Neurol. 1993;50(7):714-720. doi:10.1001/archneur.1993.00540070034011

• 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.