Mixed brain pathologies in dementia: the BrainNet Europe consortium experience.
BACKGROUND
Dementia results from heterogeneous diseases of the brain. Mixed disease forms are increasingly recognized.


METHODS
We performed a survey within brain banks of BrainNet Europe to estimate the proportion of mixed disease forms underlying dementia and age- and gender-specific influences.


RESULTS
Data collected in 9 centres from 3,303 individuals were analysed. The proportion of patients with mixed diagnoses among all cases with Alzheimer disease (AD), vascular pathology (VP), argyrophilic grain dementia (AGD), and synucleinopathies, such as Lewy body dementia (LBD), Parkinson disease (PD) and synuclein pathology only in the amygdala, was 53.3%. Mixed pathology was more frequently reported with LBD, PD, AGD, and VP than with AD. The percentage of mixed diagnoses for AGD and VP significantly differed between centres. In patients younger than 75 years, synucleinopathies, and pure forms of AD, VP, and AGD were more frequent in men. Above 75 years of age, more women had pure AD and pure AGD.


CONCLUSIONS
The most obvious neuropathological alteration should not terminate the diagnostic procedure since copathology is likely to be found. Neuropathological interpretation of AGD and VP has not been sufficiently established in a consensus. Pure forms of synucleinopathies are unlikely sole substrates for dementia.
Kovacs
Gabor G
GG
Institute of Neurology, Medical University of Vienna, Vienna, Austria.
Alafuzoff
Irina
I
Al-Sarraj
Safa
S
Arzberger
Thomas
T
Bogdanovic
Nenad
N
Capellari
Sabina
S
Ferrer
Isidro
I
Gelpi
Ellen
E
Kövari
Viktor
V
Kretzschmar
Hans
H
Nagy
Zoltan
Z
Parchi
Piero
P
Seilhean
Danielle
D
Soininen
Hilkka
H
Troakes
Claire
C
Budka
Herbert
H
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D003704:Dementia / Q000453:epidemiology* / Q000473:pathology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014015:Tissue Banks