Stroke and the Risk of Alzheimer Disease

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Abstract
THE ROLE of stroke in the pathogenesis of Alzheimer disease (AD) remains unclear.1-8 Cerebrovascular disease and its antecedents have been proposed as precursors to AD1,2 but may simply be coincident processes causing additive damage to the aging brain.8,9 Among persons with AD confirmed post mortem, those with stroke were found to have more severe dementia.10 Shared susceptibility to AD and stroke might account for the frequent association. Apolipoprotein E (APOE) is related to AD and to mortality from heart disease, but there is no established interaction between these 2 factors and AD.3,11,12 Furthermore, there is no convincing evidence of a role for the APOEϵ4allele in cerebrovascular disease.13-19 Previously, we investigated the association of diabetes and hypertension with AD in a prospective cohort of Medicare recipients living in the Washington Heights and Inwood communities of upper Manhattan, New York, NY.20,21 In this article, we have used data from this cohort to broaden the investigation of the relationship between stroke, other cardiovascular risk factors, and AD.

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