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Small vascular and Alzheimer disease-related pathologic determinants of dementia in the oldest-old

Hof, Patrick R.
Published in Journal of Neuropathology and Experimental Neurology. 2010, vol. 69, no. 12, p. 1247-1255
Abstract The relative contributions of Alzheimer disease (AD) and vascular lesion burden to the occurrence of cognitive decline are more difficult to define in the oldest-old than they are in younger cohorts. To address this issue, we examined 93 prospectively documented autopsy cases from 90 to 103 years with various degrees of AD lesions, lacunes, and microvascular pathology. Cognitive assessment was performed prospectively using the Clinical Dementia Rating scale. Neuropathologic evaluation included the Braak neurofibrillary tangle (NFT) and beta-amyloid (Abeta) protein deposition staging and bilateral semiquantitative assessment of vascular lesions. Statistics included regression models and receiver operating characteristic analyses. Braak NFTs, Abeta deposition, and cortical microinfarcts (CMIs) predicted 30% of Clinical Dementia Rating variability and 49% of the presence of dementia. Braak NFT and CMI thresholds yielded 0.82 sensitivity, 0.91 specificity, and 0.84 correct classification rates for dementia. Using these threshold values, we could distinguish 3 groups of demented cases and propose criteria for neuropathologic definition of mixed dementia, pure vascular dementia, and AD in very old age. Braak NFT staging and severity of CMI allow for defining most of demented cases in the oldest-old. Most importantly, single cutoff scores for these variables that could be used in the future to formulate neuropathologic criteria for mixed dementia in this age group were identified.
Keywords Age FactorsAged, 80 and overAlzheimer Disease/*complications/*pathology/psychologyCohort StudiesDementia, Vascular/*complications/*pathology/psychologyFemaleHumansMaleProspective Studies
PMID: 21107137
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Research groups Groupe Bouras Constantin (neuropsychiatrie) (1)
Groupe Giannakopoulos Panteleimon (psychiatrie générale) (201)
Démence du sujet âgé, troubles cognitifs, la symptomatologie cognitive (577)
(ISO format)
SINKA, Lidia et al. Small vascular and Alzheimer disease-related pathologic determinants of dementia in the oldest-old. In: Journal of Neuropathology and Experimental Neurology, 2010, vol. 69, n° 12, p. 1247-1255. doi: 10.1097/NEN.0b013e3181ffc3b9 https://archive-ouverte.unige.ch/unige:21317

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Deposited on : 2012-05-23

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