title: AD lesions and infarcts in demented and non-demented Japanese-American men.
abstract: Neocortical neuritic plaques and neurofibrillary tangles are hallmark neuropathological lesions of dementia. Concomitant cerebrovascular lesions increase dementia severity in patients meeting neuropathological criteria for Alzheimer's disease and contribute to cognitive impairment in persons with mild entorhinal Alzheimer lesions. This study investigates whether individuals with sparse neocortical neuritic plaques experience increased odds of crossing the threshold to clinical dementia when they have coexistent cerebrovascular lesions. Dementia examinations were given to 3,734 men during the 1991-1993 Honolulu-Asia Aging Study examination and to 2,603 men during the 1994-1996 examination. Lesion quantification was done without clinical data. Among 333 autopsied men, 120 had dementia, 115 had marginal results, and 98 had normal cognition. In men with neurofibrillary tangles, dementia frequency increased with increasing neuritic plaque density, and increased further in the presence of cerebrovascular lesions. The association was strongest in men with sparse neuritic plaques (1-3/mm(2)) where dementia frequency more than doubled with coexistent cerebrovascular lesions (45 vs 20%). Among all dementia cases, 24% were linked to cerebrovascular lesions. Findings suggest cerebrovascular lesions are associated with a marked excess of dementia in cases with low neuritic plaque frequency. Prevention of cerebrovascular lesions may be critically important in preserving late-life cognitive function.
authors.affiliation: Pacific Health Research Institute, Kuakini Medical Center, University of Hawaii, 846 South Hotel Street, Honolulu, HI 96813, USA. hpetrovitch@phrihawaii.org
authors.forename: Helen
authors.initials: H
authors.lastname: Petrovitch
authors.forename: G Webster
authors.initials: GW
authors.lastname: Ross
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Steinhorn
authors.forename: Robert D
authors.initials: RD
authors.lastname: Abbott
authors.forename: William
authors.initials: W
authors.lastname: Markesbery
authors.forename: Daron
authors.initials: D
authors.lastname: Davis
authors.forename: James
authors.initials: J
authors.lastname: Nelson
authors.forename: John
authors.initials: J
authors.lastname: Hardman
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Vogt
authors.forename: Lenore
authors.initials: L
authors.lastname: Launer
authors.forename: Lon R
authors.initials: LR
authors.lastname: White
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000473:pathology*; D001213:Asian; D001344:Autopsy / Q000379:methods; D002544:Cerebral Infarction / Q000473:pathology*; D015331:Cohort Studies; D003704:Dementia / Q000473:pathology / Q000503:physiopathology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D016631:Lewy Bodies / Q000473:pathology; D008297:Male; D016874:Neurofibrillary Tangles / Q000473:pathology; D009483:Neuropsychological Tests; D016017:Odds Ratio; D058225:Plaque, Amyloid / Q000473:pathology; D011180:Postmortem Changes; D011446:Prospective Studies; D012189:Retrospective Studies