Neurology®
The most widely read and highly cited peer-reviewed Neurology journal
Quick Search
Advanced Search
Published online before print June 13, 2007, doi:10.1212/01.wnl.0000271090.28148.24)
This Article
Right arrow Full Text (Rapid PDF)
Right arrow All Versions of this Article:
01.wnl.0000271090.28148.24v1
69/24/2197    most recent
Right arrow Correspondence:
Submit a response
Right arrow Correspondence:
View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Schneider, J. A.
Right arrow Articles by Bennett, D. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schneider, J. A.
Right arrow Articles by Bennett, D. A.
Received September 25, 2006
Accepted May 4, 2007

Mixed brain pathologies account for most dementia cases in community-dwelling older persons

J. A. Schneider MD*, Z. Arvanitakis MD, W. Bang MS, and D. A. Bennett MD

From Rush Alzheimer’s Disease Center and Rush Institute for Healthy Aging (J.A.S., Z.A., W.B., D.A.B.), Department of Neurological Sciences (J.A.S., Z.A., D.A.B.), and Department of Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.


* To whom correspondence should be addressed. E-mail: julie_a_schneider{at}rush.edu.

Abstract Objective: To examine the spectrum of neuropathology in persons from the Rush Memory and Aging Project, a longitudinal community-based clinical-pathologic cohort study. Methods: The study includes older persons who agreed to annual clinical evaluation and brain donation. We examined the neuropathologic diagnoses, including Alzheimer disease (AD) (NIA-Reagan Criteria), cerebral infarctions, and Parkinson disease/Lewy body disease (PD/LBD), in the first 141 autopsies. We calculated the frequency of each diagnosis alone and mixed diagnoses. We used logistic regression to compare one to multiple diagnoses on the odds of dementia. Results: Twenty persons (14.2%) had no acute or chronic brain abnormalities. The most common chronic neuropathologic diagnoses were AD (n = 80), cerebral infarctions (n = 52), and PD/LBD (n = 24). In persons with dementia (n = 50), 38.0% (n = 19) had AD and infarcts, 30.0% (n = 15) had pure AD, and 12% each had vascular dementia (n = 6) and AD with PD/LBD (n = 6). In those without dementia (n = 91), 28.6% (n = 26) had no chronic diagnostic abnormalities, 24.2% (n = 22) had pure AD, and 17.6% (n = 16) had infarctions. In persons with dementia, over 50% had multiple diagnoses (AD, PD/LBD, or infarcts), whereas, in persons without dementia, over 80% had one or no diagnosis. After accounting for age, persons with multiple diagnoses were almost three times (OR = 2.8; 95% CI = 1.2, 6.7) more likely to exhibit dementia compared to those with one pathologic diagnosis. Conclusion: The majority of community-dwelling older persons have brain pathology. Those with dementia most often have multiple brain pathologies, which greatly increases the odds of dementia.




This article has been cited by other articles:


Home page
 BrainHome page
G. D. Rabinovici, A. J. Furst, A. Alkalay, C. A. Racine, J. P. O'Neil, M. Janabi, S. L. Baker, N. Agarwal, S. J. Bonasera, E. C. Mormino, et al.
Increased metabolic vulnerability in early-onset Alzheimer's disease is not related to amyloid burden
Brain, February 1, 2010; 133(2): 512 - 528.
[Abstract] [Full Text] [PDF]

Home page
 J. Neurosci.Home page
A. D. Cohen, J. C. Price, L. A. Weissfeld, J. James, B. L. Rosario, W. Bi, R. D. Nebes, J. A. Saxton, B. E. Snitz, H. A. Aizenstein, et al.
Basal Cerebral Metabolism May Modulate the Cognitive Effects of A{beta} in Mild Cognitive Impairment: An Example of Brain Reserve
J. Neurosci., November 25, 2009; 29(47): 14770 - 14778.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
M. Fotuhi, V. Hachinski, M. Kivipelto, P. Whitehouse, D. Erten-Lyons, and J. Kaye
FACTORS ASSOCIATED WITH RESISTANCE TO DEMENTIA DESPITE HIGH ALZHEIMER DISEASE PATHOLOGY
Neurology, November 10, 2009; 73(19): 1607 - 1608.
[Full Text] [PDF]

Home page
 Am. J. Neuroradiol.Home page
J. Appel, E. Potter, N. Bhatia, Q. Shen, W. Zhao, M.T. Greig, A. Raj, W.W. Barker, H. Potter, E. Schofield, et al.
Association of White Matter Hyperintensity Measurements on Brain MR Imaging with Cognitive Status, Medial Temporal Atrophy, and Cardiovascular Risk Factors
AJNR Am. J. Neuroradiol., November 1, 2009; 30(10): 1870 - 1876.
[Abstract] [Full Text] [PDF]

Home page
 Arch NeurolHome page
J. He, S. Farias, O. Martinez, B. Reed, D. Mungas, and C. DeCarli
Differences in Brain Volume, Hippocampal Volume, Cerebrovascular Risk Factors, and Apolipoprotein E4 Among Mild Cognitive Impairment Subtypes
Arch Neurol, November 1, 2009; 66(11): 1393 - 1399.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
C. Sanz, S. Andrieu, A. Sinclair, H. Hanaire, B. Vellas, and For the REAL.FR Study Group
Diabetes is associated with a slower rate of cognitive decline in Alzheimer disease
Neurology, October 27, 2009; 73(17): 1359 - 1366.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
J. A. Luchsinger, A. M. Brickman, C. Reitz, S. J. Cho, N. Schupf, J. J. Manly, M. X. Tang, S. A. Small, R. Mayeux, C. DeCarli, et al.
Subclinical cerebrovascular disease in mild cognitive impairment
Neurology, August 11, 2009; 73(6): 450 - 456.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
E. E. Smith and S. M. Greenberg
{beta}-Amyloid, Blood Vessels, and Brain Function
Stroke, July 1, 2009; 40(7): 2601 - 2606.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
G. M. Savva, S. B. Wharton, P. G. Ince, G. Forster, F. E. Matthews, C. Brayne, and the Medical Research Council Cognitive Function an
Age, Neuropathology, and Dementia
N. Engl. J. Med., May 28, 2009; 360(22): 2302 - 2309.
[Abstract] [Full Text] [PDF]

Home page
 BrainHome page
C. R. Jack Jr, V. J. Lowe, S. D. Weigand, H. J. Wiste, M. L. Senjem, D. S. Knopman, M. M. Shiung, J. L. Gunter, B. F. Boeve, B. J. Kemp, et al.
Serial PIB and MRI in normal, mild cognitive impairment and Alzheimer's disease: implications for sequence of pathological events in Alzheimer's disease
Brain, May 1, 2009; 132(5): 1355 - 1365.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
D. A. Bennett, P. L. De Jager, S. E. Leurgans, and J. A. Schneider
Neuropathologic intermediate phenotypes enhance association to Alzheimer susceptibility alleles
Neurology, April 28, 2009; 72(17): 1495 - 1503.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
K. Kantarci, S. D. Weigand, S. A. Przybelski, M. M. Shiung, J. L. Whitwell, S. Negash, D. S. Knopman, B. F. Boeve, P. C. O'Brien, R. C. Petersen, et al.
Risk of dementia in MCI: Combined effect of cerebrovascular disease, volumetric MRI, and 1H MRS
Neurology, April 28, 2009; 72(17): 1519 - 1525.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
L. K. McEvoy, C. Fennema-Notestine, J. C. Roddey, D. J. Hagler Jr, D. Holland, D. S. Karow, C. J. Pung, J. B. Brewer, and A. M. Dale
Alzheimer Disease: Quantitative Structural Neuroimaging for Detection and Prediction of Clinical and Structural Changes in Mild Cognitive Impairment
Radiology, April 1, 2009; 251(1): 195 - 205.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
B. Kuczynski, W. Jagust, H. C. Chui, and B. Reed
An inverse association of cardiovascular risk and frontal lobe glucose metabolism
Neurology, February 24, 2009; 72(8): 738 - 743.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
O. T. Carmichael, O. Lopez, J. T. Becker, L. Kuller, N. E. Carlson, and J. A. Kaye
TRAJECTORIES OF BRAIN LOSS IN AGING AND THE DEVELOPMENT OF COGNITIVE IMPAIRMENT
Neurology, February 24, 2009; 72(8): 771 - 772.
[Full Text] [PDF]

Home page
 Cleveland Clinic Journal of MedicineHome page
S. SALLOWAY and S. CORREIA
Alzheimer disease: Time to improve its diagnosis and treatment
Cleveland Clinic Journal of Medicine, January 1, 2009; 76(1): 49 - 58.
[Abstract] [Full Text] [PDF]

Home page
 Arch NeurolHome page
K. Kantarci, R. C. Petersen, S. A. Przybelski, S. D. Weigand, M. M. Shiung, J. L. Whitwell, S. Negash, R. J. Ivnik, B. F. Boeve, D. S. Knopman, et al.
Hippocampal Volumes, Proton Magnetic Resonance Spectroscopy Metabolites, and Cerebrovascular Disease in Mild Cognitive Impairment Subtypes
Arch Neurol, December 1, 2008; 65(12): 1621 - 1628.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
V. Hachinski
Shifts in Thinking About Dementia
JAMA, November 12, 2008; 300(18): 2172 - 2173.
[Full Text] [PDF]

Home page
 RadiologyHome page
K. Kantarci, D. S. Knopman, D. W. Dickson, J. E. Parisi, J. L. Whitwell, S. D. Weigand, K. A. Josephs, B. F. Boeve, R. C. Petersen, and C. R. Jack Jr
Alzheimer Disease: Postmortem Neuropathologic Correlates of Antemortem 1H MR Spectroscopy Metabolite Measurements
Radiology, July 1, 2008; 248(1): 210 - 220.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
R. N. K. Nandigam, J. A. Schneider, Z. Arvanitakis, W. Bang, and D. A. Bennett
MIXED BRAIN PATHOLOGIES ACCOUNT FOR MOST DEMENTIA CASES IN COMMUNITY-DWELLING OLDER PERSONS
Neurology, March 4, 2008; 70(10): 816 - 817.
[Full Text] [PDF]

Home page
 NeurologyHome page
C. F. Lippa and D. S. Knopman
Dementia: Many roads, but not built in a day
Neurology, December 11, 2007; 69(24): 2193 - 2194.
[Full Text] [PDF]

Correspondence:

Read all Correspondence

Mixed brain pathologies account for most dementia cases in community-dwelling older persons
R. N. Kaveer Nandigam, MD
Neurology Online, 19 Sep 2007 [Full text]
Reply from the authors
Julie A. Schneider, et al.
Neurology Online, 19 Sep 2007 [Full text]