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Prevalence of dementia disorders in the oldest-old: an autopsy study

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Abstract

The prevalence of Alzheimer disease (AD) and vascular dementia (VD) increases with advancing age, but less so after age 90 years. A retrospective hospital-based study of the relative prevalence of different disorders was performed in 1,110 consecutive autopsy cases of demented elderly in Vienna, Austria (66% females, MMSE <20; mean age 83.3 ± 5.4 SD years). It assessed clinical, general autopsy data and neuropathology including immunohistochemistry. Neuropathologic diagnosis followed current consensus criteria. Four age groups (7–10th decade) were evaluated. In the total cohort AD pathology was seen in 82.9% (“pure” AD 42.9%; AD + other pathologies 39.9%), VD in 10.8% (mixed dementia, MIX, i.e. AD + vascular encephalopathy in 5.5%); other disorders in 5.7%, and negative pathology in 0.8%. The relative prevalence of AD increased from age 60 to 89 years and decreased slightly after age 90+, while “pure” VD diagnosed in the presence of vascular encephalopathy of different types with low neuritic AD pathology (Braak stages <3; mean 1.2–1.6) decreased progressively from age 60 to 90+; 85–95% of these patients had histories of diabetes, morphologic signs of hypertension, 65% myocardial infarction/cardiac decompensation, and 75% a history of stroke(s). Morphologic subtypes, subcortical arteriosclerotic (the most frequent), multi-infarct encephalopathy, and strategic infarct dementia showed no age-related differences. The relative prevalence of AD + Lewy pathology remained fairly constant with increasing age. Mixed dementia and AD with minor cerebrovascular lesions increased significantly with age, while other dementias decreased. This retrospective study using strict morphologic criteria confirmed increased prevalence of AD with age, but mild decline at age 90+, and progressive decline of VD, while AD + vascular pathologies including MIX showed considerable age-related increase, confirming that mixed pathologies account for most dementia cases in very old persons. A prospective clinicopathologic study in oldest-old subjects showed a significant increase in both AD and cerebral amyloid angiopathy (CAA), but decrease in VD over age 85, while in a small group of old subjects CAA without considerable AD pathology may be an independent risk factor for cognitive decline.

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Acknowledgments

The authors thank many colleagues from clinical departments and the Institute of Pathology, Otto Wagner Hospital, Vienna for clinical and autopsy data, and Mr. E. Mitter-Ferstl, PhD for secretarial and computer work. The study was supported by the Society for Support of Research in Experimental Neurology, Vienna, Austria.

Note added in proof

After termination of the present study, it was extended to a total of 1,700 demented elderly persons (671 male, 1,029 female, mean age at death 84.3 ± 6.0 years; autopsies 1981–2008), i.e. adding 590 autopsies, also divided into four age groups. The results were as follows: AD pathology was present in 80%, “pure” AD in 45.7% (36.9% Braak stage 5–6, 8.8% atypical forms), AD and other pathologies in 37.3%, VD in 12.8%, MIX in 5.2%, other degenerative dementias 4.1%, other disorders 1.6%, and negative pathology in 1.2%. The relative prevalence of AD increased from age 60 to 89 years from 38.9 to 48.9% and slightly decreased after age 90 (47.3%); MIX and AD + CVLs increased significantly from 5.2 to 10.6% and from 4.4 to 23.2% respectively (P < 0.001), while VD decreased from 15.0 to 8.7%. AD + LB pathology only slightly increased with age (7.8 to 9.4%), whereas other neurodegenerative disorders and other dementing diseases progressively decreased (21.0 to 0.4% and 5.0 to 0%, respectively). These data correlated well with those of the smaller autopsy series.

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  1. Institute of Clinical Neurobiology, Kenyongasse 18, 1070, Vienna, Austria

    Kurt A. Jellinger

  2. Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK

    Johannes Attems

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Jellinger, K.A., Attems, J. Prevalence of dementia disorders in the oldest-old: an autopsy study. Acta Neuropathol 119, 421–433 (2010). https://doi.org/10.1007/s00401-010-0654-5

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