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

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State: Public
Version: author
Serval ID
serval:BIB_4E7CFF10C474
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Small vascular and Alzheimer disease-related pathologic determinants of dementia in the oldest-old.
Journal
Journal of Neuropathology and Experimental Neurology
Author(s)
Sinka L., Kövari E., Gold G., Hof P.R., Herrmann F.R., Bouras C., Giannakopoulos P.
ISSN
0022-3069[print], 0022-3069[linking]
Publication state
Published
Issued date
2010
Peer-reviewed
Oui
Volume
69
Number
12
Pages
1247-1255
Language
english
Notes
Publication types: Comparative Study ; Journal Article Publication Status: ppublish
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 β-amyloid (Aβ) protein deposition staging and bilateral semiquantitative assessment of vascular lesions. Statistics included regression models and receiver operating characteristic analyses. Braak NFTs, Aβ 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 Factors, Aged, 80 and over, Alzheimer Disease/complications, Alzheimer Disease/pathology, Cohort Studies, Dementia, Vascular/complications, Dementia, Vascular/pathology, Female, Humans, Male, Prospective Studies
Pubmed
Web of science
Open Access
Yes
Create date
03/01/2011 14:13
Last modification date
20/08/2019 14:04
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