title: Prevalence of dementia subtypes in a developing country: a clinicopathological study.
abstract: OBJECTIVE
  To assess the distribution of dementia subtypes in Brazil using a population-based clinicopathological study.
  
  
  METHODS
  Brains from deceased individuals aged ≥50 years old were collected after the next of kin signed an informed consent form and provided information through standardized questionnaires. Post-mortem clinical diagnoses were established in consensus meetings, and only cases with moderate or severe dementia or without cognitive impairment were included in the analysis. Immunohistochemical neuropathological examinations were performed following the universally accepted guidelines. A diagnosis of Alzheimer's disease was made when there were at least both a moderate density of neuritic plaques (Consortium to Establish a Register for Alzheimer's disease B or C) and Braak stage III for neurofibrillary tangle distribution. For the diagnosis of vascular dementia, at least three zones or strategic areas had to be affected by infarcts, lacunae, or microinfarcts.
  
  
  RESULTS
  From 1,291 subjects, 113 cases were classified as having moderate or severe dementia, and 972 cases were free of cognitive impairment. The neuropathological diagnoses of the dementia sub-group were Alzheimer's disease (35.4%), vascular dementia (21.2%), Alzheimer's disease plus vascular dementia (13.3%), and other causes of dementia (30.1%). Small-vessel disease, which alone was not considered sufficient for a vascular dementia diagnosis, was present in 38.9% of all of the dementia cases and in 16.8% of the group without cognitive impairment (odds ratio = 2.91; 95% confidence interval, 1.53-5.51), adjusted for age, sex, and education.
  
  
  CONCLUSIONS
  The relatively high frequencies of vascular dementia and small-vessel disease in the dementia sub-group constitute relevant findings for public health initiatives because control of vascular risk factors could decrease the prevalence of dementia in developing countries.
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Department of Pathology, Aging Brain Study Group, LIM-22, São PauloSP, Brazil.
authors.forename: Lea T
authors.initials: LT
authors.lastname: Grinberg
authors.forename: Ricardo
authors.initials: R
authors.lastname: Nitrini
authors.forename: Claudia K
authors.initials: CK
authors.lastname: Suemoto
authors.forename: Renata Eloah de
authors.initials: RE
authors.lastname: Lucena Ferretti-Rebustini
authors.forename: Renata E P
authors.initials: RE
authors.lastname: Leite
authors.forename: Jose Marcelo
authors.initials: JM
authors.lastname: Farfel
authors.forename: Erika
authors.initials: E
authors.lastname: Santos
authors.forename: Mara Patricia Guilhermino de
authors.initials: MP
authors.lastname: Andrade
authors.forename: Ana Tereza Di Lorenzo
authors.initials: AT
authors.lastname: Alho
authors.forename: Maria do Carmo
authors.initials: Mdo C
authors.lastname: Lima
authors.forename: Katia C
authors.initials: KC
authors.lastname: Oliveira
authors.forename: Edilaine
authors.initials: E
authors.lastname: Tampellini
authors.forename: Livia
authors.initials: L
authors.lastname: Polichiso
authors.forename: Glaucia B
authors.initials: GB
authors.lastname: Santos
authors.forename: Roberta Diehl
authors.initials: RD
authors.lastname: Rodriguez
authors.forename: Kenji
authors.initials: K
authors.lastname: Ueda
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Pasqualucci
authors.forename: Wilson
authors.initials: W
authors.lastname: Jacob-Filho
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001921:Brain / Q000473:pathology; D001938:Brazil / Q000453:epidemiology; D003072:Cognition Disorders; D003704:Dementia / Q000145:classification / Q000453:epidemiology* / Q000473:pathology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors
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