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Mix of Disease Process in Brain Leads to Dementia

According to a new study by researchers in National Institutes of Health, an individuals likelihood of having clinical signs of dementia increases with the number of different disease processes present in the brain.

Among their findings is the observation that the combination of Alzheimers disease and cerebral infarcts (strokes) is the most common mix of pathologies in the brains of people with dementia. The implication of these findings is that public health efforts to prevent and treat vascular disease could potentially reduce the occurrence of dementia, the researchers say in the paper.

The researchers used data from the Rush Memory and Aging Projectan ongoing study of 1,200 elderly volunteers who have agreed to be evaluated every year and to donate their brains upon death. The current study compared clinical and autopsy data on the first 141 participants who have died.

Annual physical and psychological exams showed that, while they were alive, 50 of the 141 had dementia. Upon death, a neuropathologist, who was unaware of the results of the clinical evaluation, analyzed each persons brain. The autopsies showed that about 85 percent of the individuals had evidence of at least one chronic disease process, such as Alzheimers disease, strokes, Parkinsons disease, hemorrhages, tumors, traumatic brain injury or others.

Comparison of the clinical and autopsy results showed that only 30 percent of people with signs of dementia had Alzheimers disease alone. By contrast, 42 percent of the people with dementia had Alzheimers disease with infarcts and 16 percent had Alzheimers disease with Parkinsons disease (including two people with all three conditions).

Infarcts alone caused another 12 percent of the cases. Also, 80 of the 141 volunteers who died had sufficient Alzheimers disease pathology in their brains to fulfill accepted neuropathologic criteria for Alzheimers disease, although in life only 47 were clin ically diagnosed with probable or possible Alzheimers disease.

We know that people can have Alzheimers pathology without having symptoms, says Dallas Anderson, Ph.D., population studies program director in the NIA Neuroscience and Neuopsychology of Aging Program.

The finding that Alzheimers pathology with cerebral infarcts is a very common combination in people with dementia adds to emerging evidence that we might be able to reduce some of the risk of dementia with the same tools we use for cardiovascular disease such as control of blood cholesterol levels and hypertension.

NIA is conducting clinical trials to determine whether interventions for cardiovascular disease can prevent or slow the progress of Alzheimers disease. On-going trials cover a range of interventions such as statin drugs, vitamins and exercise.


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