O2‐05‐05: Factors associated with cognitive impairment in persons with autopsy Braak stage 4 or greater: Results from the Honolulu‐Asia Aging Study (HAAS)
Year: 2010
Type: article
Study design: Observational Study
Abstract: The existence and severity of cognitive impairment in persons found at autopsy to have the neuropathologic lesions of Alzheimer's disease (AD) is variable. Analyses of data from autopsies on HAAS decedents utilized measures of AD and other dementia-related neuropathologic lesions, scores from the Cognitive Assessment and Screening Instrument (CASI) administered in the final years and months before death, standardized dementia diagnoses, and information related to cognitve facility collected during the 45 year course of the study. Among 443 brain autopsies of HAAS decedents, 260 were found to have Braak stages of 4 (n = 120), 5 (n = 119), or 6 (n = 21). Dementia or definite cognitive impairment was confirmed in the final years of life in 45% of those classified as Braak stage 4, 53% of stage 5, and 86% of stage 6 . The braak stage itself (4, 5, or 6) explained 5.5% of the variance in the final Cognitive Assessment and Screening Instrument (CASI) score. Educational attainment, estimated intracranial volume, and age at death added an additional 6.3%. The further influence of isocortical neurofibrillary tangle counts (20 fields, 4 left hemisphere lobes), isocortical neuritic plaque counts, an index of cerebrovascular amyloid angiopathy, and apolipoprotein E4 zygosity increased the total variance explained to 23.5%. The further consideration of co-prevalent hippocampal sclerosis, alpha-synuclein inclusions, and microinfarcts added 7.8% to the variance explained. Consideration of estimated brain atrophy added another 7.3%, bringing the total variance explained to 38.6%. In a subset of 120 brains (of the 260 with Braak stage 4, 5, or 6) having neglibible levels of co-prevalent hippocampal sclerosis, alpha synuclein inclusions, and microinfarcts, atrophy nonetheless contributed 8.2% to the total variance explained. These results emphasize the importance of co-prevalent brain lesions and generalized brain atrophy as major influencers of cognitive impairment and dementia in persons with clinical-pathologically significant Alzheimer brain disease.
Source: Alzheimer s & Dementia
Institutions: Pacific Health Research and Education Institute, Kuakini Medical Center, United States Department of Veterans Affairs, VA Pacific Islands Health Care System, University of Hawaiʻi at Mānoa, University of Hawaii System, University of Kentucky, National Institutes of Health, National Institute on Aging
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2160118450