title: Factors associated with resistance to dementia despite high Alzheimer disease pathology.
abstract: BACKGROUND
  Autopsy series have shown that some elderly people remain with normal cognitive function during life despite having high burdens of pathologic lesions associated with Alzheimer disease (AD) at death. Understanding why these individuals show no cognitive decline, despite high AD pathologic burdens, may be key to discovery of neuroprotective mechanisms.
  
  
  METHODS
  A total of 36 subjects who on autopsy had Braak stage V or VI and moderate or frequent neuritic plaque scores based on Consortium to Establish a Registry for Alzheimer's Disease (CERAD) standards were included. Twelve had normal cognitive function and 24 a diagnosis of AD before death. Demographic characteristics, clinical and pathologic data, as well as antemortem brain volumes were compared between the groups.
  
  
  RESULTS
  In multiple regression analysis, antemortem hippocampal and total brain volumes were significantly larger in the group with normal cognitive function after adjusting for gender, age at MRI, time from MRI to death, Braak stage, CERAD neuritic plaque score, and overall presence of vascular disease.
  
  
  CONCLUSIONS
  Larger brain and hippocampal volumes were associated with preserved cognitive function during life despite a high burden of Alzheimer disease (AD) pathologic lesions at death. A better understanding of processes that lead to preservation of brain volume may provide important clues for the discovery of mechanisms that protect the elderly from AD.
authors.affiliation: Veterans Affairs Medical Center, Portland, OR, USA. ertenlyo@ohsu.edu
authors.forename: D
authors.initials: D
authors.lastname: Erten-Lyons
authors.forename: R L
authors.initials: RL
authors.lastname: Woltjer
authors.forename: H
authors.initials: H
authors.lastname: Dodge
authors.forename: R
authors.initials: R
authors.lastname: Nixon
authors.forename: R
authors.initials: R
authors.lastname: Vorobik
authors.forename: J F
authors.initials: JF
authors.lastname: Calvert
authors.forename: M
authors.initials: M
authors.lastname: Leahy
authors.forename: T
authors.initials: T
authors.lastname: Montine
authors.forename: J
authors.initials: J
authors.lastname: Kaye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000209:etiology* / Q000473:pathology* / Q000523:psychology; D001921:Brain / Q000473:pathology; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D003704:Dementia / Q000209:etiology / Q000473:pathology / Q000523:psychology; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009922:Oregon; D009929:Organ Size / Q000502:physiology; D058225:Plaque, Amyloid / Q000473:pathology; D012307:Risk Factors