The enigma of mixed dementia

Jellinger, K. A.

doi:10.1016/j.jalz.2006.09.002

Cited by 120 publications

(98 citation statements)

References 140 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent staging strategy proposing semiquantitative assessment of CVLs in 4 brain areas with a score from I to IV/VI [183] (Table 3) Mixed type dementia, occurring in 25 to 80% of elderly demented persons, is diagnosed when a combination of several pathologies, e.g. AD with cerebrovascular lesions and/or Lewy pathology, is present [184][185][186][187]. CVD and vascular brain injury commonly are encountered in the brains of seniors with and without AD pathology [175,180,184,185], but uniform and reproducible criteria are currently not available.…”

Section: Diagnostic Criteria For Other Dementiasmentioning

confidence: 99%

“…AD with cerebrovascular lesions and/or Lewy pathology, is present [184][185][186][187]. CVD and vascular brain injury commonly are encountered in the brains of seniors with and without AD pathology [175,180,184,185], but uniform and reproducible criteria are currently not available. Subcortical CVLs were more frequent in AD patients than in nondemented controls and more frequent in severely demented patients with early onset AD [188].…”

Section: Diagnostic Criteria For Other Dementiasmentioning

confidence: 99%

“…About two-thirds of aged human brains show non-AD-type neuropathology [229,[278][279][280], which, however, frequently has been missed clinically and could not be identified without neuropathologic examination [72]. Since 50 to 85% of the brains of persons who die aged 80-90+ show appreciable CVLs [281], a specific problem is the impact of CVLs in relation to AD pathology [175,185,237,[282][283][284]. In several autopsy series of very old people, the frequency of AD ranged from 12 to 66%, that of VaD from 9 to 46.8%, that of DLB between 9 and 24%, and that of mixed pathologies between 2 and 86% (!…”

Section: The Importance Of Multiple Pathologiesmentioning

confidence: 99%

“…), and was over 40% in a large autopsy series of patients over age 80 [270] (Table 4). The burden of vascular and AD type pathologies are considered to be independent of each other, and are consistent with an additive or synergistic effect of both types of lesions on cognitive impairment [147,175,185,272,[286][287][288][289][290][291]. The thresholds for vascular and degenerative lesions in distinguishing "pure" VaD or AD from mixed cases have been discussed [274,292,293].…”

mentioning

confidence: 99%

“…The thresholds for vascular and degenerative lesions in distinguishing "pure" VaD or AD from mixed cases have been discussed [274,292,293]. AD pathology alone more frequently accounts for dementia than both microscopic and macroscopic infarcts [294], and in full-blown stages of AD concomitant small vascular lesions do not significantly influence the overall state and progression of cognitive decline, the severity and extent of AD pathology overwhelming the effects of CVD [175,185,295,296]. In a recent autopsy study, global AD pathology significantly correlated to global cognition, whereas infarcts and Lewy bodies did not [234].…”

mentioning

confidence: 99%

See 4 more Smart Citations

Neuropathology of Dementia Disorders

Jellinger¹

2014

J Alzheimers Dis Parkinsonism

View full text Add to dashboard Cite

IntroductionDementia, encompassing deficits in several cognitive domains that are severe enough to interfere with daily functioning [1], in the new DSM V classification is classified within the broad category of major neurocognitive disorders, proposing specific criteria for the various etiologies [2]. Previously defined as the manifestation of deteriorating brain functions over time due to cell deaths in the brain caused by neurodegeneration or any other disease [3], according to recent research dementia is not primarily caused by neuronal cell death/loss, but by dysfunction and loss of synapses [4] in AD [5] and in α-synucleinopathies [6]. Other causes include cholinergic neuronal and axonal abnormalities [7,8], as well as pre-and postsynaptic cortical cholinergic deficits also occurring in early AD [9]. These changes due to disconnection of major nervous circuitries causing default networks [10][11][12][13] have been demonstrated in vivo in early AD [14], suggesting that disease progress is transmitted by neuronal pathways [15]. A prionlike spread of misfolded protein aggregates in the pathogenesis and progression of neurodegeneration is a hot spot of discussion [16][17][18][19][20][21].Both the prevalence and incidence of dementia increase exponentially with age. In 2010, 35.6 million people worldwide lived with dementia, with around 8 million new cases every year. Numbers are expected to double or triple every 5-10 years, to 135 millions in 2050, 16 millions in Europe. In 2010, 58% of all demented people lived in low-cost countries, with their proportion anticipated to rise to 71% in 2050 [22]. According to recent data from China the incidence of dementia was 9.87/1000 person years and the median standardised mortality ratio was 1.94:1 [23]. With the disproportional growth of the elderly population, dementia has become a major public health and socio-economic problem that threatens to become the scourge of our century. The total costs for dementia were US$ 604 billion in 2010 worldwide, up to 70% for social care alone [24], total payments for AD for 2013 were expected to be $ 203 billion in USA alone, not included contributions of unpaid caregivers [25]. Neuropathology of Dementia DisordersKurt A Jellinger* Institute of Clinical Neurobiology, Kenyongasse 18, A 1070, Vienna, Austria AbstractDementia, being not a specific disease but a syndrome characterized by deficits in several cognitive domains, is a major public health and socio-economic problem of our century. It is caused by dysfunction/loss of synapses and neurons inducing default neuronal networks. Despite updated concensus criteria for the clinical diagnosis of the major neurodegenerative disorders and new biomarkers, the diagnostic accuracy ranges from 65 to 96% (for Alzheimer's disease /AD), with a sensitivity versus other dementias of around 85.4% and a specificity of up to 77.7%. Pathologic assessment, using genetic and molecular biological methods, based on homogenous definitions, harmonized interlaboratory and assessment standards, can achiev...

show abstract

Section: Diagnostic Criteria For Other Dementiasmentioning

confidence: 99%

Section: Diagnostic Criteria For Other Dementiasmentioning

confidence: 99%

Section: The Importance Of Multiple Pathologiesmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Neuropathology of Dementia Disorders

Jellinger¹

2014

J Alzheimers Dis Parkinsonism

View full text Add to dashboard Cite

show abstract

Determining If Sex Bias Exists in Human Surgical Clinical Research

et al. 2016

View full text Add to dashboard Cite

Importance Sex is a variable that is poorly controlled for in clinical research. Objective Determine if sex bias exists in human surgical clinical research, determine if data are reported and analyzed using sex as an independent variable, and identify specialties where the greatest and least sex biases exist. Design Review and data abstraction from published peer-reviewed manuscripts. Setting All original peer-reviewed manuscripts published in 2011 and 2012 in Annals of Surgery, American Journal of Surgery, JAMA Surgery, Journal of Surgical Research, and Surgery. Main Outcome Measures Study type, location, number and sex of subjects, sex matching, and inclusion of sex-based reporting, statistical analysis, and discussion of data. Results Of 2,347 articles reviewed, 1,668 included human subjects. After excluding 365 articles, 1,303 manuscripts remained: 17 (1%) included only males, 41 (3%) included only females, 1,020 (78%) included males and females, and 225 (17%) did not document the sex of the subjects. While females represent over 50% of the total number of subjects included, considerable variability existed with the number of male, female, and unspecified subjects included among the journals, between US domestic and international studies, and between single versus multi-center studies. For manuscripts included in the study, only 38% reported these data by sex, 33% analyzed these data by sex, and 23% included a discussion of sex-based results. Sex matching of the subjects included in the research was poor, with only 18% of the studies matching the inclusion of both sexes by 80%. Upon analysis of the different surgical specialties, a wide variation in sex-based inclusion, matching, and data reporting existed, with colorectal surgery having the best matching of males and females and cardiac surgery having the worst. Conclusion Our data show that sex bias exists in human surgical clinical research. Few studies included men and women equally, less than one-third performed data analysis by sex, and there was wide variation in inclusion and matching of the sexes among the specialties and the journals reviewed. Because clinical research serves as the foundation for evidence-based medicine, it is imperative that this disparity be addressed so that therapies benefit both sexes.

show abstract

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

1,958

653

View full text Add to dashboard Cite

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid‐century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.

show abstract

The enigma of mixed dementia

Cited by 120 publications

References 140 publications

Neuropathology of Dementia Disorders

Neuropathology of Dementia Disorders

Determining If Sex Bias Exists in Human Surgical Clinical Research

2020 Alzheimer's disease facts and figures

Contact Info

Product

Resources

About