Comorbid amyloid‐β pathology affects clinical and imaging features in VCD

To date, the clinical relevance of comorbid amyloid‐β (Aβ) pathology in patients with vascular cognitive disorders (VCD) is largely unknown. Methods We included 218 VCD patients with available cerebrospinal fluid Aβ 42 levels. Patients were divided into Aβ+ mild‐VCD (n = 84), Aβ− mild‐VCD (n = 68), Aβ+ major‐VCD (n = 31), and Aβ− major‐VCD (n = 35). We measured depression with the Geriatric Depression Scale, cognition with a neuropsychological test battery and derived white matter hyperintensities (WMH) and gray matter atrophy from MRI. Results Aβ− patients showed more depressive symptoms than Aβ+. In the major‐VCD group, Aβ− patients performed worse on attention ( P  = .02) and executive functioning ( P  = .008) than Aβ+. We found no cognitive differences in patients with mild VCD. In the mild‐VCD group, Aβ− patients had more WMH than Aβ+ patients, whereas conversely, in the major‐VCD group, Aβ+ patients had more WMH. Atrophy patterns did not differ between Aβ+ and Aβ− VCD group. Discussion Comorbid Aβ pathology affects the manifestation of VCD, but effects differ by severity of VCD.