Neuropathological Diagnoses in Elderly Patients in Oslo: Alzheimers Disease, Lewy Body Disease, Vascular Lesions

Abstract

Neuropathological changes in elderly residents of Oslo, Norway, were characterised with respect to the cerebral substrates of dementia. Ninety-two brains were examined, representing 41% of all deaths occurring in 10 nursing homes during a 9-month period. The autopsy cohort showed a similar mean age (85 years) and sex ratio (73% female) and proportion of demented patients (75%) compared to all the patients resident in these homes who died during the same period. Clinical data was compiled retrospectively. Diagnosis was made using the CERAD protocol, and criteria for the diagnosis of Lewy body dementia. Lewy body formation was present in 20% and cerebral infarction in 21% of patients. In the demented group (69 patients) 90% fulfilled CERAD criteria for definite or probable Alzheimer’s disease. Eight demented cases had absent neocortical neurofibrillary tangles and 6 other cases showed Lewy body dementia (9% of demented patients). A further 8 of these demented cases had brain stem Lewy bodies with only minimal cortical involvement. Thirteen cases (19% of the sample) had cerebral infarcts but these were considered to be clinically significant in only 4 (6%). In the non-demented patients (23) 4 patients had brain stem Lewy bodies and 6 had cerebral infarcts. Despite inclusion criteria biased towards the collection of Alzheimer''s disease and normal patients, both Lewy body dementia (7%) and cerebral infarcts contributing to dementia (6%) were frequent

Genetic association between the APOE * 4 allele and Lewy bodies in Alzheimer disease

“…However, they did not use systematic AS immunohistochemistry for LB detection. [19][20][21][22][23][24][25] Two studies that also used the LB509 antibody reported that approximately 50% of cases with familial AD and Down syndrome with concomitant AD have coexistent LBs. 26,27 Therefore, we anticipate that our observed LB prevalence is comparable with that observed in other AD research centers.…”

Demensdiagnostikk - automatisert kvantifisering av hjernestrukturer

“…Dette er ikke uventet. Ifølge nevropatologiske undersøkelser har mange med kliniske demenssymptomer en blanding av ulike demenssykdommer (36). Om lag 75 % av dem med diagnosen nevropatologisk demens med lewylegemer har samtidig nevropatologiske forandringer i hjernen som indikerer en samtidig Alzheimers sykdom (37).…”

“…Om lag 75 % av dem med diagnosen nevropatologisk demens med lewylegemer har samtidig nevropatologiske forandringer i hjernen som indikerer en samtidig Alzheimers sykdom (37). Kombinasjon av vaskulaer demens, demens med lewylegemer og demens av Alzheimers type er heller ikke uvanlig (36). Det er mulig at en automatisert MR-analyse ville klart å skille demens av Alzheimers type fra frontotemporal demens, men gruppen med fronttotemporal demens er for liten for å teste denne hypotesen.…”

Lewy body dementia: clinical manifestations, diagnosis, and treatment

“…Частота ДТЛ среди всех причин деменции составляет от 7 до 30% [8,13,14]. На первых этапах исследования, ве-роятно, имела место как низкая, так и чрезмерная диагно-стика заболевания: в части случаев ДТЛ расценивалась как БА, болезнь Паркинсона (БП) с деменцией, супрануклеар-ный паралич.…”

“…По данным некоторых авторов [13,22], ДТЛ чаще страдают мужчины (66% мужчин и 34% женщин) в отличие от БА, которой преимущественно болеют женщины. По мнению других исследователей, не отмечается преобладания того или иного пола.…”