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Pathological correlates of dementia in an unselected community sample of elderly people


, : Pathological correlates of dementia in an unselected community sample of elderly people. Society for Neuroscience Abstracts 26(1-2): Abstract No -201 8

It is assumed that diagnostic protocols for dementia used in specialist practice apply in the community. Neuropathology was performed on 209 deceased respondents who had participated in a prospective community-based study of cognitive function in the elderly. Respondents in the MRC Cognitive Function and Ageing Study were approached for brain donation with ethical approval. Dementia was assigned using the AGECAT organicity algorithm. Neuropathology used the CERAD protocol. Cerebrovascular (78%) and Alzheimer-type pathology (ATP)(70%)were frequent. Dementia was present in 47%, of whom 64% had ATP indicating probable or definite Alzheimer's disease, but 33% of non-demented people had equivalent densities of neuritic plaques. Neocortical tangles were found in 60% of demented people and 35% of non-demented, the latter including 10% with moderate or severe neocortical tangles. Vascular lesions were equally frequent, although multiple vascular pathologies were increased in the demented group (p=0.04; OR1.9, 95%CI 1.04-3.4). ATP and vascular pathology were the major pathological correlates of cognitive decline in this elderly sample. Most had mixed disease. There are no clear thresholds which predict dementia status in this sample, challenging conventional diagnostic criteria for dementia in this setting. Additional factors must determine what burden of cerebral ATP and vascular lesions are associated with cognitive failure in a particular individual.

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