No difference in the prevalence of Alzheimer-type neurodegenerative changes in the brains of suicides when compared with controls: an explorative neuropathologic study

  • Jakob MatschkeEmail author
  • Susanne Sehner
  • Jürgen Gallinat
  • Julia Siegers
  • Melanie Murroni
  • Klaus Püschel
  • Markus Glatzel
Original Paper


Suicide ranks among the leading causes of death for individuals of all ages with highest rates in the elderly. The cause of suicide is considered a multifactorial phenomenon. A variety of neurodegenerative diseases, notably Alzheimer’s disease, or, more recently, tauopathies as frontotemporal lobar degeneration or chronic traumatic encephalopathy, has been suggested as risk factor for suicide. Accordingly, we hypothesized that neurodegenerative changes typical of these diseases should be more prevalent in the brains of suicides when compared with controls. Suicides from the German federal state of Hamburg (n = 162) were compared with age- and sex-matched controls who died of other cause. Neuropathological assessment included semiquantitative analysis of neuritic plaques and neurofibrillary tangles visualized with silver stains; in addition, quantitative immunohistochemical analysis of β-amyloid load and counts of tau-positive neurofibrillary tangles and neuropil threads was done. Univariate analysis and multivariable conditional logistic regression models did not show an effect of any parameter associated with the odds of committing suicide. On the contrary, after stratification for age, older suicide victims (over 48 years) showed lower β-amyloid loads when compared to controls in the univariate analysis (suicides: 4.7 ± 12.9; controls: 9.9 ± 20.9; p = 0.031; r = − 0.17). In conclusion, neuropathological characteristics of Alzheimer’s disease and common tauopathies associated with age seem to be of limited relevance for suicides. However, intact cognition when planning and carrying out complex acts may be of importance in the context of suicide.


Suicide Alzheimer’s disease Chronic traumatic encephalopathy Neurodegeneration Dementia Depression 



We are thankful for the excellent technical assistance of our laboratory staff at the Institute of Neuropathology.

Compliance with ethical standards

Conflict of interest



  1. 1.
    Turecki G, Brent DA (2016) Suicide and suicidal behaviour. Lancet 387:1227–1239CrossRefPubMedGoogle Scholar
  2. 2.
    Mann JJ (2003) Neurobiology of suicidal behaviour. Nat Rev Neurosci 4:819–828CrossRefPubMedGoogle Scholar
  3. 3.
    Cavanagh JTO, Carson AJ, Sharpe M et al (2003) Psychological autopsy studies of suicide: a systematic review. Psychol Med 33:395–405CrossRefPubMedGoogle Scholar
  4. 4.
    Turvey CL, Conwell Y, Jones MP et al (2002) Risk factors for late-life suicide: a prospective, community-based study. Am J Geriatr Psychiatry 10:398–406CrossRefPubMedGoogle Scholar
  5. 5.
    Rubenowitz E, Waern M, Wilhelmson K et al (2001) Life events and psychosocial factors in elderly suicides—a case-control study. Psychol Med 31:1193–1202CrossRefPubMedGoogle Scholar
  6. 6.
    Waern M, Rubenowitz E, Runeson B et al (2002) Burden of illness and suicide in elderly people: case-control study. BMJ 324:1355CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Waern M, Runeson BS, Allebeck P et al (2002) Mental disorder in elderly suicides: a case-control study. Am J Psychiatry 159:450–455CrossRefPubMedGoogle Scholar
  8. 8.
    Waern M, Rubenowitz E, Wilhelmson K (2003) Predictors of suicide in the old elderly. Gerontology 49:328–334CrossRefPubMedGoogle Scholar
  9. 9.
    Conwell Y, Duberstein PR, Caine ED (2002) Risk factors for suicide in later life. Biol Psychiatry 52:193–204CrossRefPubMedGoogle Scholar
  10. 10.
    Carney SS, Rich CL, Burke PA et al (1994) Suicide over 60: the San Diego study. J Am Geriatr Soc 42:174–180CrossRefPubMedGoogle Scholar
  11. 11.
    Forsell Y, Jorm AF, Winblad B (1997) Suicidal thoughts and associated factors in an elderly population. Acta Psychiatr Scand 95:108–111CrossRefPubMedGoogle Scholar
  12. 12.
    Ferri CP, Prince M, Brayne C et al (2005) Global prevalence of dementia: a Delphi consensus study. Lancet 366:2112–2117CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Haw C, Harwood D, Hawton K (2009) Dementia and suicidal behavior: a review of the literature. Int Psychogeriatr 21:440–453CrossRefPubMedGoogle Scholar
  14. 14.
    Lyketsos CG, Lopez O, Jones B et al (2002) Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA 288:1475–1483CrossRefPubMedGoogle Scholar
  15. 15.
    Burns A, Jacoby R, Luthert P et al (1990) Cause of death in Alzheimer’s disease. Age Ageing 19:341–344CrossRefPubMedGoogle Scholar
  16. 16.
    Knopman DS, Kitto J, Deinard S et al (1988) Longitudinal study of death and institutionalization in patients with primary degenerative dementia. J Am Geriatr Soc 36:108–112CrossRefPubMedGoogle Scholar
  17. 17.
    Peisah C, Snowdon J, Kril J et al (2007) Clinicopathological findings of suicide in the elderly: three cases. Suicide Life Threat Behav 37:648–658CrossRefPubMedGoogle Scholar
  18. 18.
    Seyfried LS, Kales HC, Ignacio RV et al (2011) Predictors of suicide in patients with dementia. Alzheimers Dement 7:567–573CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Harris EC, Barraclough B (1997) Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 170:205–228CrossRefPubMedGoogle Scholar
  20. 20.
    Harwood D, Hawton K, Hope T et al (2001) Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case-control study. Int J Geriatr Psychiatry 16:155–165CrossRefPubMedGoogle Scholar
  21. 21.
    Snowdon J, Baume P (2002) A study of suicides of older people in Sydney. Int J Geriatr Psychiatry 17:261–269CrossRefPubMedGoogle Scholar
  22. 22.
    Chiu HF, Lam LC, Pang AH et al (1996) Attempted suicide by Chinese elderly in Hong Kong. Gen Hosp Psychiatry 18:444–447CrossRefPubMedGoogle Scholar
  23. 23.
    Erlangsen A, Mortensen PB, Vach W et al (2005) Psychiatric hospitalisation and suicide among the very old in Denmark: population-based register study. Br J Psychiatry 187:43–48CrossRefPubMedGoogle Scholar
  24. 24.
    Erlangsen A, Vach W, Jeune B (2005) The effect of hospitalization with medical illnesses on the suicide risk in the oldest old: a population-based register study. J Am Geriatr Soc 53:771–776CrossRefPubMedGoogle Scholar
  25. 25.
    Erlangsen A, Zarit SH, Tu X et al (2006) Suicide among older psychiatric inpatients: an evidence-based study of a high-risk group. Am J Geriatr Psychiatry 14:734–741CrossRefPubMedGoogle Scholar
  26. 26.
    Lyness JM, Conwell Y, Nelson JC (1992) Suicide attempts in elderly psychiatric inpatients. J Am Geriatr Soc 40:320–324CrossRefPubMedGoogle Scholar
  27. 27.
    Schneider B, Maurer K, Frölich L (2001) Dementia and suicide. Fortschr Neurol Psychiatr 69:164–169CrossRefPubMedGoogle Scholar
  28. 28.
    Fisk JD, Beattie BL, Donnelly M et al (2007) Disclosure of the diagnosis of dementia. Alzheimers Dementia 3:404–410CrossRefGoogle Scholar
  29. 29.
    Margo GM, Finkel JA (1990) Early dementia as a risk factor for suicide. Hosp Community Psychiatry 41:676–678PubMedGoogle Scholar
  30. 30.
    Vega U, Kishikawa Y, Ricanati E et al (2002) Suicide and Alzheimer disease. Am J Geriatr Psychiatry 10:484–485CrossRefPubMedGoogle Scholar
  31. 31.
    Ferris SH, Hofeldt GT, Carbone G et al (1999) Suicide in two patients with a diagnosis of probable Alzheimer disease. Alzheimer Dis Assoc Disord 13:88–90CrossRefPubMedGoogle Scholar
  32. 32.
    Kishikawa Y, Friedland RP, Ueda H et al (2007) Socio-psychological factors in suicide with Alzheimer’s disease: comparative case studies of two patients in the USA and Japan. Psychogeriatrics 7:37–39CrossRefGoogle Scholar
  33. 33.
    Rohde K, Peskind ER, Raskind MA (1995) Suicide in two patients with Alzheimer’s disease. J Am Geriatr Soc 43:187–189CrossRefPubMedGoogle Scholar
  34. 34.
    Lim WS, Rubin EH, Coats M et al (2005) Early-stage Alzheimer disease represents increased suicidal risk in relation to later stages. Alzheimer Dis Assoc Disord 19:214–219CrossRefPubMedGoogle Scholar
  35. 35.
    Dyer C (2013) Dignitas accepts the first case of suicide for dementia from the UK. BMJ 346:f3595CrossRefPubMedGoogle Scholar
  36. 36.
    Cipriani G, Vedovello M, Lucetti C et al (2013) Dementia and suicidal behavior. Aggress Violent Behav 18:656–659CrossRefGoogle Scholar
  37. 37.
    Ayalon L, Mackin S, Arean PA et al (2007) The role of cognitive functioning and distress in suicidal ideation in older adults. J Am Geriatr Soc 55:1090–1094CrossRefPubMedGoogle Scholar
  38. 38.
    Davis DS (2014) Alzheimer disease and pre-emptive suicide. J Med Ethics 40:543–549CrossRefPubMedGoogle Scholar
  39. 39.
    Dresser R (2014) Pre-emptive suicide, precedent autonomy and preclinical Alzheimer disease. J Med Ethics 40:550–551CrossRefPubMedGoogle Scholar
  40. 40.
    Dickson DW (2005) Required techniques and useful molecular markers in the neuropathologic diagnosis of neurodegenerative diseases. Acta Neuropathol 109:14–24CrossRefPubMedGoogle Scholar
  41. 41.
    Duyckaerts C, Delatour B, Potier MC (2009) Classification and basic pathology of Alzheimer disease. Acta Neuropathol 118:5–36CrossRefPubMedGoogle Scholar
  42. 42.
    Price JL, McKeel DW Jr, Buckles VD et al (2009) Neuropathology of nondemented aging: presumptive evidence for preclinical Alzheimer disease. Neurobiol Aging 30:1026–1036CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Sieben A, Van Langenhove T, Engelborghs S et al (2012) The genetics and neuropathology of frontotemporal lobar degeneration. Acta Neuropathol 124:353–372CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    McKee AC, Stein TD, Nowinski CJ et al (2013) The spectrum of disease in chronic traumatic encephalopathy. Brain 136:43–64CrossRefPubMedGoogle Scholar
  45. 45.
    Omalu BI, DeKosky ST, Minster RL et al (2005) Chronic traumatic encephalopathy in a National Football League player. Neurosurgery 57:128–134CrossRefPubMedGoogle Scholar
  46. 46.
    Omalu BI, DeKosky ST, Hamilton RL et al (2006) Chronic traumatic encephalopathy in a national football league player: part II. Neurosurgery 59:1086–1092CrossRefPubMedGoogle Scholar
  47. 47.
    Omalu BI, Bailes J, Hammers JL et al (2010) Chronic traumatic encephalopathy, suicides and parasuicides in professional American athletes: the role of the forensic pathologist. Am J Forensic Med Pathol 31:130–132CrossRefPubMedGoogle Scholar
  48. 48.
    Iverson GL (2014) Chronic traumatic encephalopathy and risk of suicide in former athletes. Br J Sports Med 48:162–165CrossRefPubMedGoogle Scholar
  49. 49.
    Iverson GL (2016) Suicide and chronic traumatic encephalopathy. J Neuropsychiatry Clin Neurosci 28:9–16CrossRefPubMedGoogle Scholar
  50. 50.
    Mirra SS, Heyman A, McKeel D et al (1991) The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer’s disease. Neurology 41:479–486CrossRefPubMedGoogle Scholar
  51. 51.
    Kellner A, Matschke J, Bernreuther C et al (2009) Autoantibodies against beta-amyloid are common in Alzheimer’s disease and help control plaque burden. Ann Neurol 65:24–31CrossRefPubMedGoogle Scholar
  52. 52.
    Dawson TP, Neal JW, Llewellyn L et al (2003) Neuropathology techniques. Arnold, LondonGoogle Scholar
  53. 53.
    Alafuzoff I, Pikkarainen M, Arzberger T et al (2008) Inter-laboratory comparison of neuropathological assessments of beta-amyloid protein: a study of the BrainNet Europe consortium. Acta Neuropathol 115:533–546CrossRefPubMedGoogle Scholar
  54. 54.
    Gau SS, Cheng AT (2004) Mental illness and accidental death. Case-control psychological autopsy study. Br J Psychiatry 185:422–428CrossRefPubMedGoogle Scholar
  55. 55.
    Isometsa ET (2001) Psychological autopsy studies–a review. Eur Psychiatry 16:379–385CrossRefPubMedGoogle Scholar
  56. 56.
    Blennow K, de Leon MJ, Zetterberg H (2006) Alzheimer’s disease. Lancet 368:387–403CrossRefPubMedGoogle Scholar
  57. 57.
    Peisah C, Snowdon J, Gorrie C et al (2007) Investigation of Alzheimer’s disease-related pathology in community dwelling older subjects who committed suicide. J Affect Disord 99:127–132CrossRefPubMedGoogle Scholar
  58. 58.
    Rubio A, Vestner AL, Stewart JM et al (2001) Suicide and Alzheimer’s pathology in the elderly: a case-control study. Biol Psychiatry 49:137–145CrossRefPubMedGoogle Scholar
  59. 59.
    Tagliavini F, Giaccone G, Frangione B et al (1988) Preamyloid deposits in the cerebral cortex of patients with Alzheimer’s disease and nondemented individuals. Neurosci Lett 93:191–196CrossRefPubMedGoogle Scholar
  60. 60.
    Tagliavini F, Giaccone G, Verga L et al (1991) Alzheimer patients: preamyloid deposits are immunoreactive with antibodies to extracellular domains of the amyloid precursor protein. Neurosci Lett 128:117–120CrossRefPubMedGoogle Scholar
  61. 61.
    Dickson DW (1997) The pathogenesis of senile plaques. J Neuropathol Exp Neurol 56:321–339CrossRefPubMedGoogle Scholar
  62. 62.
    Fiala JC (2007) Mechanisms of amyloid plaque pathogenesis. Acta Neuropathol 114:551–571CrossRefPubMedGoogle Scholar
  63. 63.
    Salib E, Tadros G (2000) Brain weight in suicide. An exploratory study. Br J Psychiatry 177:257–261CrossRefPubMedGoogle Scholar
  64. 64.
    Hamilton SJ, McMahon RF (2002) Sudden death and suicide: a comparison of brain weight. Br J Psychiatry 181:72–75CrossRefPubMedGoogle Scholar
  65. 65.
    Balazic J, Marusic A (2002) Apparent higher brain weight in suicide victims: possible reasons. Psychol Rep 90:236–238CrossRefPubMedGoogle Scholar
  66. 66.
    Sabodash V, Mendez MF, Fong S et al (2013) Suicidal behavior in dementia: A special risk in semantic dementia. Am JAlzheimers Dis Other Demen 28:592–599CrossRefGoogle Scholar
  67. 67.
    Alberici A, Cottini E, Cosseddu M et al (2012) Suicide risk in frontotemporal lobe degeneration to be considered, to be prevented. Alzheimer Dis Assoc Disord 26:194–196CrossRefPubMedGoogle Scholar
  68. 68.
    Synofzik M, Biskup S, Leyhe T et al (2012) Suicide attempt as the presenting symptom of C9orf72 dementia. Am J Psychiatry 169:1211–1213CrossRefPubMedGoogle Scholar
  69. 69.
    Halpin M (2012) Accounts of suicidality in the Huntington disease community. Omega (Westport) 65:317–334CrossRefGoogle Scholar
  70. 70.
    Hubers AA, Reedeker N, Giltay EJ et al (2012) Suicidality in Huntington’s disease. J Affect Disord 136:550–557CrossRefPubMedGoogle Scholar
  71. 71.
    Brüne M, Schöbel A, Karau R et al (2011) Neuroanatomical correlates of suicide in psychosis: the possible role of von Economo neurons. PLoS One 6:e20936CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Forensic NeuropathologyUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  2. 2.Institute of NeuropathologyUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  3. 3.Department of Medical Biometry and EpidemiologyUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  4. 4.Department of Psychiatry and PsychotherapyUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  5. 5.Institute of Legal MedicineUniversity Medical Centre Hamburg-EppendorfHamburgGermany

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