Multiple pathologies are common and related to dementia in the oldest-old

Abstract

Objective: The purpose of this study was to examine the role of multiple pathologies in the expression of dementia in the oldest-old.Methods: A total of 183 participants of The 901 Study with longitudinal follow-up and autopsy were included in this clinical-pathologic investigation. Eight pathologic diagnoses (Alzheimer disease [AD], microinfarcts, hippocampal sclerosis, macroinfarcts, Lewy body disease, cerebral amyloid angiopathy, white matter disease, and others) were dichotomized. We estimated the odds of dementia in relation to each individual pathologic diagnosis and to the total number of diagnoses. We also examined dementia severity in relation to number of pathologic diagnoses.Results: The presence of multiple pathologic diagnoses was common and occurred more frequently in those with dementia compared with those without dementia (45% vs 14%). Higher numbers of pathologic diagnoses were also associated with greater dementia severity. Participants with intermediate/high AD pathology alone were 3 times more likely to have dementia (odds ratio 5 3.5), but those with single non-AD pathologies were 12 times more likely to have dementia (odds ratio 5 12.4). When a second pathology was present, the likelihood of dementia increased 4-fold in those with intermediate/high AD pathology but did not change in those with non-AD pathologies, suggesting that pathologies may interrelate in different ways. Conclusions:In the oldest-old, the presence of multiple pathologies is associated with increased likelihood and severity of dementia. The effect of the individual pathologies may be additive or perhaps synergistic and requires further research. Multiple pathologies will need to be targeted to reduce the burden of dementia in the population. Neurology ® 2015;85:535-542

Neuropathologic comorbidity and cognitive impairment in the Nun and Honolulu-Asia Aging Studies

“…In 2015, it was shown that the presence of multiple pathologic diagnoses occurred more frequently in those with dementia compared with those without dementia in 183 participants of the 901 Study. 23 Despite support for the significance of comorbid neuropathologic abnormalities in dementia in older adults, a large-scale comprehensive examination of their frequencies and overall neurocognitive effects has not yet been reported. Here we address this gap by parallel analyses in 2 distinct population-based brain autopsy panels, the predominantly Caucasian NS women and the Japanese American HAAS men.…”

Current Pathogenetic Concepts of Vascular Cognitive Impairment

“…The prevalence studies must be interpreted cautiously since aged subjects with and without dementia show a high frequency of mixed pathologies [18][19][20][21][22].…”

Modern Approaches to Diagnostics and Therapy of Alzheimer Disease

“…Проведенные недавно эпидемиологические исследования «80+» и «90+» показали [18], что зависи-мость развития БА от возраста не является линейной. Так, действительно, частота развития БА увеличивается с возраста 50 до 75-80 лет; у людей старше 80 и тем более старше 90 лет частота распространения БА, напротив, снижается.…”