Lack of association between acute stroke, post-stroke dementia, race, and β-amyloid status

• Published in: NeuroImage clinical Vol. 29; p. 102553
• Main Authors: Koenig, Lauren N., McCue, Lena M., Grant, Elizabeth, Massoumzadeh, Parinaz, Roe, Catherine M., Xiong, Chengjie, Moulder, Krista L., Wang, Liang, Zazulia, Allyson R., Kelly, Peggy, Dincer, Aylin, Zaza, Aiad, Shimony, Joshua S., Benzinger, Tammie L.S., Morris, John C.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.01.2021; Elsevier
• Subjects: African American; Aged; Alzheimer Disease; Amyloid beta-Peptides; Amyloid PET; Brain Ischemia; Case-Control Studies; Female; Humans; MRI; Preclinical Alzheimer Disease; Regular; Retrospective Studies; Stroke; Stroke - complications; Stroke; Preclinical Alzheimer Disease; MRI; Amyloid PET; African American
• ISSN: 2213-1582; 2213-1582
• DOI: 10.1016/j.nicl.2020.102553

•Amyloid PET not different for those with and without acute stroke.•Amyloid PET not different for those that developed post-stroke dementia.•Amyloid PET not different for African American and non-Hispanic white participants.•African Americans more likely to have microbleeds and small infarcts. Stroke and Alzheimer disease share risk factors and often co-occur, and both have been reported to have a higher prevalence in African Americans as compared to non-Hispanic whites. However, their interaction has not been established. The objective of this study was to determine if preclinical Alzheimer disease is a risk factor for stroke and post-stroke dementia and whether racial differences moderate this relationship. This case-control study was analyzed in 2019 using retrospective data from 2007 to 2013. Participants were adults age 65 and older with and without acute ischemic stroke. Recruitment included word of mouth and referrals in Saint Louis, MO, with stroke participants recruited from acutely hospitalized patients and non-stroke participants from community living older adults who were research volunteers. Our assessment included radiologic reads of infarcts, microbleeds, and white matter hyperintensitites (WMH); a Pittsburgh Compound B PET measure of cortical β-amyloid binding; quantitative measures of hippocampal and WMH volume; longitudinal Mini Mental State Examination (MMSE) scores; and Clinical Dementia Rating (CDR) 1 year post-stroke. A total of 243 participants were enrolled, 81 of which had a recent ischemic stroke. Participants had a mean age of 75, 57% were women, and 52% were African American. Cortical amyloid did not differ significantly by race, stroke status, or CDR post-stroke. There were racial differences in MMSE scores at baseline (mean 26.8 for African Americans, 27.9 for non-Hispanic whites, p = 0.03), but not longitudinally. African Americans were more likely to have microbleeds (32.8% vs 22.6%, p = 0.04), and within the acute stroke group, African Americans were more likely to have small infarcts (75.6% vs 56.8%, p = 0.049). Preclinical Alzheimer disease did not show evidence of being a risk factor for stroke nor predictive of post-stroke dementia. We did not observe racial differences in β-amyloid levels. However, even after controlling for several vascular risk factors, African Americans with clinical stroke presentations had greater levels of vascular pathology on MRI.