Open AccessImpact of Alzheimer's Disease, Lewy Body and Vascular Co-Pathologies on Clinical Transition to Dementia in a National Autopsy Cohort
Author(s) -
Jagan A. Pillai,
Robert S. Butler,
Aaron BonnerJackson,
James B. Leverenz
Publication year - 2016
Publication title -
dementia and geriatric cognitive disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.026
H-Index - 110
eISSN - 1421-9824
pISSN - 1420-8008
DOI - 10.1159/000448243
Subject(s) - dementia , autopsy , lewy body , cohort , alzheimer's disease , disease , vascular dementia , degenerative disease , dementia with lewy bodies , medicine , psychology , cohort study , pathology
Aims: We examined the effect of vascular or Lewy body co-pathologies in subjects with autopsy-confirmed Alzheimer's disease (AD) on the rate of cognitive and functional decline and transition to dementia. Methods: In an autopsy sample of prospectively characterized subjects from the National Alzheimer's Coordinating Center database, neuropathology diagnosis was used to define the groups of pure AD (pAD, n = 84), mixed vascular and AD (ADV, n = 54), and mixed Lewy body disease and AD (ADLBD, n = 31). Subjects had an initial Clinical Dementia Rating-Global (CDR-G) score 1, ≥3 evaluations, and Braak tangle stage ≥III. We compared the rate of cognitive and functional decline between the groups. Results: The rate of functional and cognitive decline was lower for ADV, and ADV patients had less severe deficits on CDR-G and the CDR-Sum of Boxes scores at the last visit than pAD and ADLBD patients. No significant differences were noted between ADLBD and pAD patients. After controlling for age at death, the odds of reaching CDR ≥1 at the last visit were lower in the ADV subjects compared to the pAD subjects. Conclusions: The mean rate of functional and cognitive decline among ADV subjects was slower than among either pAD or ADLBD patients. Vascular pathology did not increase the odds of attaining CDR ≥1 when occurring with AD in this national cohort.