Population-based longitudinal clinicopathological studies provide an ideal opportunity to study a variety of risk
and protective factors in relation to pathology associated with dementia in individuals who are representative of the general
population. The 90+ Study is a population-based study designed specifically to study aging and dementia as well as
its neuropathological correlates in participants 90 years of age and older. We present demographic and pathological data
on the first 104 participants to come to autopsy from the brain donation component of the study, The 90+ Autopsy Study.
Cognitive diagnosis was assigned according to Diagnostic and Statistical Manual 4th edition criteria for dementia and neuropathological
diagnoses were made according to the Consortium to Establish a Registry for Alzheimer’s Disease protocol.
Dementia was present in 61% of autopsied participants, the majority of whom were diagnosed with Alzheimer’s disease
(85%). Many different types of pathology typically associated with dementia were common in the oldest-old, and included
neurofibrillary tangles, neuritic plaques, diffuse plaques, Lewy bodies, hippocampal sclerosis, and cerebral infarctions.
Most types of pathology were more frequently found in participants suffering from dementia but there was extensive
overlap in pathology among those with and without dementia. In addition, 22% of demented participants did not have
sufficient pathology to account for their cognitive loss. Our results highlight the poor associations between these common
pathological lesions and dementia in the oldest-old and the importance of considering many different types of pathology,
possibly including some yet to be identified, in order to account for all dementias in the oldest-old.
Keywords: Dementia, alzheimer’s disease, cohort study, longitudinal studies, neuropathology, oldest-old, aging, neuropathology
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