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NEUROPATHOLOGICAL LESIONS IN THE VERY OLD: RESULTS FROM A LARGE BRAZILIAN AUTOPSY STUDY

Authors
  • Suemoto, Claudia K.1
  • Leite, Renata E. P.1
  • Ferretti-Rebustini, Renata E. L.2
  • Rodriguez, Roberta D.3
  • Nitrini, Ricardo3
  • Pasqualucci, Carlos A.4
  • Jacob-Filho, Wilson1
  • Grinberg, Lea T.4, 5
  • 1 Division of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • 2 Department of Medical Surgical Nursing, University of Sao Paulo School of Nursing, Sao Paulo, Brazil
  • 3 Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • 4 Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
  • 5 Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, USA
Type
Published Article
Journal
Brain Pathology
Publisher
Wiley (Blackwell Publishing)
Publication Date
Apr 10, 2019
Volume
29
Issue
6
Pages
771–781
Identifiers
DOI: 10.1111/bpa.12719
PMID: 30861605
PMCID: PMC6742578
Source
PubMed Central
Keywords
License
Unknown

Abstract

Objective: To compare neuropathological correlates of cognitive impairment between very old and younger individuals from a Brazilian clinicopathological study. Methods: We assessed the frequency of neuropathological lesions and their association with cognitive impairment (Clinical Dementia Rating scale≥0.5) in the 80 or over age group compared to younger participants, using logistic regression models adjusted for sex, race, and education. Results: Except for infarcts and siderocalcinosis, all neuropathological lesions were more common in the 80 or over age group (n=412) compared to 50–79 year olds (n=677). Very old participants had more than twice the likelihood of having ≥2 neuropathological diagnoses than younger participants (OR=2.66, 95% CI=2.03–3.50). Neurofibrillary tangles, infarcts, and hyaline arteriolosclerosis were associated with cognitive impairment in the two age groups. Siderocalcinosis was associated with cognitive impairment in the younger participants only, while Lewy body disease was associated with cognitive impairment in the very old only. In addition, we found that the association of infarcts and multiple pathologies with cognitive impairment was attenuated in very old adults (Infarcts: p for interaction=0.04; and multiple pathologies: p=0.05). However, the predictive value for the aggregate model with all neuropathological lesions showed similar discrimination in both age groups [Area under Receiver Operating Characteristic curve (AUR0C)=0.778 in younger participants and AUR0C=0.765 in the very old]. Conclusion and relevance: Despite a higher frequency of neuropathological findings in the very old group, as found in studies with high-income populations, we found attenuation of the effect of infarcts rather than neurofibrillary tangles and plaques as reported previously.

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