title: The neuropathology of older persons with and without dementia from community versus clinic cohorts.
abstract: Community-based cohorts of older persons may differ neuropathologically from clinic-based cohorts. This study investigated age-related pathologies in persons with and without dementia and included autopsied participants from two community-based cohorts, the Rush Religious Orders Study (n=386) and the Memory and Aging Project (n=195), and one clinic-based cohort, the Clinical Core of the Rush Alzheimer's Disease Center (n=392). Final clinical diagnoses included no cognitive impairment (n=202), mild cognitive impairment (MCI) (n=150), probable Alzheimer's disease (AD) (n=474), possible AD (n=88), and other dementias (n=59). Postmortem diagnoses included pathologic AD, cerebral infarcts, and Lewy body disease. Community-based persons with clinical AD had less severe AD pathology (p<0.001) and had more cerebral infarcts (p<0.001) compared to clinic-based persons. Additionally, community-based persons with MCI had more infarcts compared to clinic-based persons. Overall, there was a higher proportion of Lewy bodies and atypical pathologies in the clinic-based compared to the community-based cohorts (p<0.001). Community-based persons with probable AD show less severe AD pathology and more often have infarcts and mixed pathologies; those with MCI more often have infarcts and mixed pathologies. Overall, clinic-based persons have more Lewy bodies and atypical pathologies. The spectrum of pathologies underlying cognitive impairment in clinic-based cohorts differs from community-based cohorts.
authors.affiliation: Department of Pathology (Neuropathology) and Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Armour Academic Center, 600 South Paulina Street, Suite 1022F, Chicago, IL 60612, USA. julie_a_schneider@rush.edu
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schneider
authors.forename: Neelum T
authors.initials: NT
authors.lastname: Aggarwal
authors.forename: Lisa
authors.initials: L
authors.lastname: Barnes
authors.forename: Patricia
authors.initials: P
authors.lastname: Boyle
authors.forename: David A
authors.initials: DA
authors.lastname: Bennett
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D000544:Alzheimer Disease / Q000453:epidemiology / Q000473:pathology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data*; D003704:Dementia / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D008569:Memory Disorders / Q000175:diagnosis / Q000453:epidemiology; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D014019:Tissue Donors