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S1‐03‐01: Brain imaging in the presymptomatic detection, tracking and prevention of Alzheimer's disease
Author(s) -
Reiman Eric M.
Publication year - 2009
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2009.05.167
Subject(s) - neuropathology , apolipoprotein e , biomarker , neuroimaging , medicine , magnetic resonance imaging , disease , imaging biomarker , positron emission tomography , oncology , cognitive decline , alzheimer's disease neuroimaging initiative , pathology , alzheimer's disease , neuroscience , dementia , psychology , psychiatry , nuclear medicine , radiology , genetics , biology
features, not necessary for primary diagnosis, may be of interest in describing the extent of general amyloidoses, vascular damage, or other abnormalities that may have influenced the primary disease process. Methods: We analyzed data collected by approximately 30 U.S.A.based Alzheimer’s Disease Centers, stored in the NACC database [U01 AG016976]. We chose comparison groups by primary neuropathologic diagnosis: normal brain, AD, Lewy body disease (LBD), vascular disease/dementia, and Frontotemporal Lobar Degeneration (FTLD). A total of 8068 subjects had these diagnoses (48.6% were male and about 53% died at age 80 or older). We examined the occurrence of the following neuropathologic features within each primary diagnosis category: neurofibrillary tangles (Braak stage), neuritic and diffuse plaques, vascular features (e.g., infarcts, athero-, arterio-sclerosis, amyloid angiopathy), Lewy bodies and features related to FTLD. Understandably, some diagnostic groups did not have all the features assessed on all subjects.; however, complete-case data (where all pathologic features were assessed), were available for 2181 subjects. Results: Of 348 subjects with a primary neuropathologic diagnosis of ‘‘normal brain’’, approximately 15% had Braak stage (NFT) of III or greater, 23% had frequent or moderate cortical neuritic plaques, and 26% had frequent or moderate diffuse plaques. Of 4798 AD subjects, 12% and 18% had one or more large artery infarcts or micro infarcts, respectively, and of those assessed, 36% showed moderate to severe atherosclerosis, 29% showed moderate to severe arteriosclerosis, and about 18% had Lewy bodies. LBD subjects exhibited vascular pathology in similar frequency to AD subjects and about 40% also had Braak stage V-VI. The complete case subset also showed similar results. Conclusions: Neuropathologic features associated with dementias, other than those which define the primary disease, co-occurred frequently in this series. Results indicate that several disease processes may be either independently present or interact in some way, to potentiate or attenuate other pathologies, or their clinical expression. Further investigation to determine the timing of such pathologies will increase pathologic and clinical understanding.