• Natalie L Marchant, Bruce R Reed, Nerses Sanossian, Cindee M Madison, Stephen Kriger, Roxana Dhada, Wendy J Mack, Charles DeCarli, Michael W Weiner, Dan M Mungas, Helena C Chui, and William J Jagust.
• Helen Wills Neuroscience Institute, University of California, Berkeley, 132 Barker Hall, Mail Code 3190, Berkeley, CA 94720, USA. nlmarchant@gmail.com
• JAMA Neurol. 2013 Apr 1; 70 (4): 488-95.

Importanceβ-Amyloid (Aβ) deposition and vascular brain injury (VBI) frequently co-occur and are both associated with cognitive decline in aging. Determining whether a direct relationship exists between them has been challenging. We sought to understand VBI's influence on cognition and clinical impairment, separate from and in conjunction with pathologic changes associated with Alzheimer disease (AD).ObjectiveTo examine the relationship between neuroimaging measures of VBI and brain Aβ deposition and their associations with cognition.Design And SettingA cross-sectional study in a community- and clinic-based sample recruited for elevated vascular disease risk factors.ParticipantsClinically normal (mean age, 77.1 years [N = 30]), cognitively impaired (mean age, 78.0 years [N = 24]), and mildly demented (mean age, 79.8 years [N = 7]) participants.InterventionsMagnetic resonance imaging, Aβ (Pittsburgh Compound B-positron emission tomographic [PiB-PET]) imaging, and cognitive testing.Main Outcome MeasuresMagnetic resonance images were rated for the presence and location of infarct (34 infarct-positive participants, 27 infarct-negative participants) and were used to quantify white matter lesion volume. The PiB-PET uptake ratios were used to create a PiB index by averaging uptake across regions vulnerable to early Aβ deposition; PiB positivity (29 PiB-positive participants, 32 PiB-negative participants) was determined from a data-derived threshold. Standardized composite cognitive measures included executive function and verbal and nonverbal memory.ResultsVascular brain injury and Aβ were independent in both cognitively normal and impaired participants. Infarction, particularly in cortical and subcortical gray matter, was associated with lower cognitive performance in all domains (P < .05 for all comparisons). Pittsburgh Compound B positivity was neither a significant predictor of cognition nor interacted with VBI.Conclusions And RelevanceIn this elderly sample with normal cognition to mild dementia, enriched for vascular disease, VBI was more influential than Aβ in contemporaneous cognitive function and remained predictive after including the possible influence of Aβ. There was no evidence that VBI increases the likelihood of Aβ deposition. This finding highlights the importance of VBI in mild cognitive impairment and suggests that the impact of cerebrovascular disease should be considered with respect to defining the etiology of mild cognitive impairment.

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