Journal of Alzheimer's Disease - Volume 18, issue 3

Authors: Schneider, Julie A. | Aggarwal, Neelum T. | Barnes, Lisa | Boyle, Patricia | Bennett, David A.

Article Type: Research Article

Abstract: Community-based cohorts of older persons may differ neuropathologically from clinic-based cohorts. This study investigated age-related pathologies in persons with and without dementia and included autopsied participants from two community-based cohorts, the Rush Religious Orders Study (n=386) and the Memory and Aging Project (n=195), and one clinic-based cohort, the Clinical Core of the Rush Alzheimer's Disease Center (n=392). Final clinical diagnoses included no cognitive impairment (n=202), mild cognitive impairment (MCI) (n=150), probable Alzheimer's disease (AD) (n=474), possible AD (n=88), and other dementias (n=59). Postmortem diagnoses included pathologic AD, cerebral infarcts, and Lewy body disease. Community-based persons with clinical AD had less …severe AD pathology (p<0.001) and had more cerebral infarcts (p<0.001) compared to clinic-based persons. Additionally, community-based persons with MCI had more infarcts compared to clinic-based persons. Overall, there was a higher proportion of Lewy bodies and atypical pathologies in the clinic-based compared to the community-based cohorts (p<0.001). Community-based persons with probable AD show less severe AD pathology and more often have infarcts and mixed pathologies; those with MCI more often have infarcts and mixed pathologies. Overall, clinic-based persons have more Lewy bodies and atypical pathologies. The spectrum of pathologies underlying cognitive impairment in clinic-based cohorts differs from community-based cohorts. Show more

Keywords: Clinic, community, epidemiology, neuropathology, selection bias

DOI: 10.3233/JAD-2009-1227

Citation: Journal of Alzheimer's Disease, vol. 18, no. 3, pp. 691-701, 2009

Authors: Sonnen, Joshua A. | Larson, Eric B. | Haneuse, Sebastien | Woltjer, Randy | Li, Ge | Crane, Paul K. | Craft, Suzanne | Montine, Thomas J.

Article Type: Research Article

Abstract: The neuropathology underlying dementia syndromes in older populations is complex. The contributions of Alzheimer's and Lewy body pathology are well appreciated. Recent studies with brain autopsies have highlighted the high prevalence of vascular disease as an independent, but often co-morbid contributor to dementia. The Adult Changes in Thought Study is a community-based, longitudinal study of brain aging and cognitive decline which has recently confirmed cerebral microinfarcts as a strong correlate of cognitive impairment and dementia. This study examines correlations between clinical characteristics including extensive, longitudinal medication histories, and longitudinal cognitive testing against structural and biochemical features of disease.

Keywords: Aging, community-based, microinfarct, longitudinal, neuropathology

DOI: 10.3233/JAD-2009-1180

Citation: Journal of Alzheimer's Disease, vol. 18, no. 3, pp. 703-711, 2009

Authors: White, Lon

Article Type: Research Article

Abstract: This report summarizes findings from 443 autopsies on Japanese-American men followed as active participants in the Honolulu-Asia Aging Study from 1991 through 2003. Five distinct neuropathological lesion types were found to have strong, partially, or completely independent associations with cognitive impairment and/or dementia in the final years of life. They were: Alzheimer lesions (neocortical neurofibrillary tangles and neuritic plaques), microvascular infarcts (microinfarcts and lacunar infarcts), neocortical Lewy bodies, hippocampal sclerosis, and generalized brain atrophy. Atrophy was strongly associated with both Alzheimer lesions and microvascular infarcts, but was also observed in decedents with negligible levels of these and the other lesions. …About half of the hippocampal sclerosis cases appeared to be linked to Alzheimer lesions. A weak association of hippocampal sclerosis with microvascular infarcts was also noted. Comparable 3-level indices were defined for each of the five lesion types to facilitate comparisons of associations with cognitive impairment and dementia. Multiple combinations of the five lesion types were observed. The development of dementia in the final years of life was more closely correlated with their combined numbers and severities than with specific lesion types. In this autopsy panel, microvascular infarcts were identified as the sole or dominant lesion in 33.8% of the demented or definitely impaired decedents, compared with Alzheimer lesions in 18.6% and co-dominant lesions (most often Alzheimer and microvascular) in 14.2%. These or one or more of the other lesion types were observed in 87.9% of the demented or definitely impaired decedents. Show more

Keywords: Autopsy, brain, dementia, epidemiology, neuropathology

DOI: 10.3233/JAD-2009-1178

Citation: Journal of Alzheimer's Disease, vol. 18, no. 3, pp. 713-725, 2009

Article Type: Correction

DOI: 10.3233/JAD-2009-18324

Citation: Journal of Alzheimer's Disease, vol. 18, no. 3, pp. 727-727, 2009