Recent clinical-pathologic research on the causes of dementia in late life: update from the Honolulu-Asia Aging Study.
In this study, we compare neuropathological findings at autopsy with clinical dementia diagnoses, such as Alzheimer's disease and vascular dementia. Participants consisted of 363 aged Japanese-American men from the Honolulu-Asia Aging Study. Results indicated that the correspondence between clinical and neuropathologic diagnosis was not great, with 56% of patients diagnosed with probable or possible Alzheimer's disease during life but with only 19% having neuritic plaques and/or neurofibrillary tangles as the sole or dominant dementia-related lesions in the brain at autopsy. Although 16% of cases were attributed to mixed causes during life, almost 40% were found to have significant mixtures of dementia-related lesions at autopsy. Finally, both Alzheimer's disease and non-Alzheimer's disease neuropathologic lesions contributed independently to the explanation of variance on a test of overall cognitive performance. The results suggest that clinical diagnosis of dementia made during life may fail to reflect the pathogenic complexity of this condition in very elderly persons.
White
Lon
L
Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, USA. lrwhite@phrihawaii.org
Small
Brent J
BJ
Petrovitch
Helen
H
Ross
G Webster
GW
Masaki
Kamal
K
Abbott
Robert D
RD
Hardman
John
J
Davis
Daron
D
Nelson
James
J
Markesbery
William
W
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000544:Alzheimer Disease / Q000503:physiopathology*; D001213:Asian; D001344:Autopsy; D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003704:Dementia / Q000503:physiopathology*; D006801:Humans; D008609:Mental Status Schedule; D016874:Neurofibrillary Tangles; D058225:Plaque, Amyloid; D012307:Risk Factors