Small vascular and alzheimer disease-related pathologic determinants of dementia in the oldest-old

Lidia Sinka, Enikö Kövari, Gabriel Gold, Patrick R. Hof, François R. Herrmann, Constantin Bouras, Panteleimon Giannakopoulos

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


The relative contributions of Alzheimer disease (AD) and vascular lesion burden to the occurrence of cognitive decline are more difficult to define in the oldest-old than they are in younger cohorts. To address this issue, we examined 93 prospectively documented autopsy cases from 90 to 103 years with various degrees of AD lesions, lacunes, and microvascular pathology. Cognitive assessment was performed prospectively using the Clinical Dementia Rating scale. Neuropathologic evaluation included the Braak neurofibrillary tangle (NFT) and β-amyloid (Aβ) protein deposition staging and bilateral semiquantitative assessment of vascular lesions. Statistics included regression models and receiver operating characteristic analyses. Braak NFTs, Aβ deposition, and cortical microinfarcts (CMIs) predicted 30% of Clinical Dementia Rating variability and 49% of the presence of dementia. Braak NFT and CMI thresholds yielded 0.82 sensitivity, 0.91 specificity, and 0.84 correct classification rates for dementia. Using these threshold values, we could distinguish 3 groups of demented cases and propose criteria for neuropathologic definition of mixed dementia, pure vascular dementia, and AD in very old age. Braak NFT staging and severity of CMI allow for defining most of demented cases in the oldest-old. Most importantly, single cutoff scores for these variables that could be used in the future to formulate neuropathologic criteria for mixed dementia in this age group were identified.

Original languageEnglish
Pages (from-to)1247-1255
Number of pages9
JournalJournal of Neuropathology and Experimental Neurology
Issue number12
StatePublished - Dec 2010


  • Alzheimer disease
  • Brain aging
  • Mixed dementia
  • Oldest-old
  • Vascular dementia


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