We sought to evaluate differences in clinical profiles at mild cognitive impairment (MCI) and early dementia stages between those with arteriosclerosis alone (pARTE), Alzheimer's disease (AD) alone (pAD), and AD with arteriosclerosis (ADARTE) using retrospective clinical data on autopsy-confirmed cases from the National Alzheimer’s Coordinating Center (NACC) database.

AD and cerebral small vessel disease are common causes of dementia. They often co-exist but can be difficult to distinguish and their exact clinical interaction is unclear.

We defined groups of pARTE (n=34), pAD (n=189), and ADARTE (n=256) from NACC neuropathology diagnoses. Subjects included had moderate to severe arteriosclerosis and/or ABC score for AD of 2-3, without other major neuropathology. We compared demographics, vascular risk factors, cognitive testing, and neuropsychiatric symptoms across neuropathology groups and subgroups of apolipoprotein (APOE) allele variants at first evaluation with Global Clinical Dementia Rating (CDR) score of 0.5 and 1.0, corresponding to MCI and early dementia stages respectively.

Clinical differences between pARTE, pAD, and ADARTE emerge at early dementia rather than MCI. Diabetes plays a more prominent role in pARTE dementia. APOE4 allele has varied associations within neuropathology groups at different stages.