Cited by 174Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsNeurological Disease Mechanisms and Treatments

The DOI matches its Crossref record; 36 of the 36 references it cites were found in a registry or an index; 3 of the 8 sources its claims cite were checked for support.

Ecology of the Aging Human Brain

Open access
Sonnen, Joshua A.·2011·Archives of Neurology

Abstract

BACKGROUND: Alzheimer disease, cerebral vascular brain injury, and isocortical Lewy body disease (LBD) are the major contributors to dementia in community- and population-based studies. OBJECTIVE: To estimate the prevalence of clinically silent forms of these diseases in cognitively normal (CN) adults. DESIGN: Autopsy study. SETTING: Community- and population based. PARTICIPANTS: A total of 1672 brain autopsies from the Adult Changes in Thought study, Honolulu-Asia Aging Study, Nun Study, and Oregon Brain Aging Study, of which 424 met the criteria for CN. MAIN OUTCOME MEASURES: Of these, 336 cases had a comprehensive neuropathologic examination of neuritic plaque density, Braak stage for neurofibrillary tangles, LB distribution, and number of cerebral microinfarcts. RESULTS: Forty-seven percent of CN cases had moderate or frequent neuritic plaque density; of these, 6% also had Braak stage V or VI for neurofibrillary tangles. Fifteen percent of CN cases had medullary LBD; 8% also had nigral and 4% isocortical LBD. The presence of any cerebral microinfarcts was identified in 33% and of high-level cerebral microinfarcts in 10% of CN individuals. Overall, the burden of lesions in each individual and their comorbidity varied widely within each study but were similar across studies. CONCLUSIONS: These data show an individually varying complex convergence of subclinical diseases in the brain of older CN adults. Appreciating this ecology should help guide future biomarker and neuroimaging studies and clinical trials that focus on community- and population-based cohorts.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In harmonized autopsies from four community- or population-based cohorts, clinically silent Alzheimer’s disease, microvascular brain injury, and Lewy body disease were common in cognitively normal older adults, with widely varying individual burden and co-morbidity. The findings suggest that the aging brain often contains multiple subclinical dementia-associated lesions, which should inform biomarker, neuroimaging, and prevention studies.

Key findings

  • Among 336 cognitively normal (CN) older adults with complete neuropathologic examination, 47% had moderate or frequent neuritic plaque (NP) density; only 6% of those also had Braak stage V or VI neurofibrillary tangles.
  • Lewy body disease (LBD) showed an apparent anatomic progression: 15% had medullary LBD, 8% also had nigral LBD, and 4% also had isocortical LBD.
  • Any cerebral microinfarcts (CMIs) were identified in 33% of CN individuals, and high-level CMIs (≥3) in 10%; there was no significant correlation between CERAD NP score and CMI categories.
  • Summary neuropathology score differed significantly across CN, lower cognitive function, and dementia groups (Kruskal-Wallis P < 0.0001; Dunn’s paired post tests P < 0.0001 for each comparison), and 10–15% of CN individuals harbored clinically silent AD, μVBI, and/or LBD at levels equal to or exceeding the average burden in dementia cases.

Methods

  • The study evaluated 1,672 brain autopsies from the Adult Changes in Thought (ACT) study, Honolulu-Asia Aging Study (HAAS), Nun Study (NS), and Oregon Brain Aging Study (OBAS); 424 met criteria for CN, and 336 had complete neuropathologic examination.
  • CN was defined as last clinical evaluation within 2 years of death, diagnosis of “not dementia,” and cognitive screening scores in the upper four quintiles (MMSE ≥24 for NS, MMSE ≥28 for OBAS, CASI ≥83 for HAAS, CASI >90 for ACT).
  • Harmonized histopathologic assessment included CERAD NP score, Braak staging for NFTs, α-synuclein immunohistochemistry for LBs, and screening H&E-stained sections for CMIs across the same 12 sections from six bilateral cerebral regions; analyses used descriptive prevalence, a summary neuropathology score, and non-parametric tests in GraphPad Prism.

Limitations

  • The paper states that interpretation of these cross-sectional autopsy data is limited, that the interval between last clinical evaluation and autopsy creates potential for misclassification especially given prodromal dementia, and that neuropathologic protocols likely have varying sensitivities.
  • The paper notes that LBD data were not collected identically across all studies (medulla in two studies, substantia nigra in three, isocortex in all four), that missing CMI data were the most frequent cause of incomplete evaluation, and that caution is needed in extrapolating findings to other ethnic or racial groups or societies.
  • Evident from the text: only 336 of 424 CN cases had complete neuropathologic evaluation, and the four cohorts differed in size, age, and sex composition, which the authors note may affect age-related correlation results.

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Integrity signals

Registry

Crossref · 10.1001/archneurol.2011.157

Cites

36 of 36 references verified0 citation errors · 0 not checkable

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Claims the paper makes

27 Own result · 14 Own interpretation · 7 Own method · 4 No full text of the sources · 1 Supported · 1 Partly supported · accuracy not yet measured

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  • It may state two separate claims as one. 13
  • The quote only partly states this claim. 1
  • Probably not a substantial claim. 10
24 of 24
  • The paper relies on this without support.

    There are as yet no validated neuroimaging or biomarker protocols for μVBI or LBD, so current information on clinically silent forms of these diseases is available only from autopsy-based studies.

    “Since there are as yet no validated neuroimaging or biomarker protocols for μVBI or LBD, current information on clinically silent forms of these diseases is available only from autopsy-based studies.”
  • The paper relies on this without support.

    The screening protocol for CMIs has been shown independently in HAAS and ACT to be correlated with other forms of VBI, such as lacunes and territorial infarcts.

    “This screening protocol for CMIs has been shown independently in HAAS and ACT to be correlated with others forms of VBI, such as lacunes and territorial infarcts.”
2 of 2

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Citations

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Research works printed but not linked: 1

  1. [17]Montine TJ Sonnen JA Mini-Forum on Clinical-Pathologic Correlations in Population- and Community-Based Studies of Brain Aging Journal of Alzheimer’s disease 2009 18 643 725

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Metadata

Authors
Sonnen, J. A.
Affiliations
University of Washington (US)
Corresponding author
Sonnen, Joshua A.
Venue
Archives of Neurology
Published
2011-08-01
Volume
68
Issue
8
Pages
1049
ISSN
0003-9942 (ISSN-L)
OpenAlex
W2131428961
Cited by
174
References
36
Citations by year
2026: 4 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 13 · 2021: 16 · 2020: 10 · 2019: 10 · 2018: 8 · 2017: 15 · 2016: 18 · 2015: 15 · 2014: 14 · 2013: 17 · 2012: 13
FWCI
9.05
Type
journal article
Language
en
Open access
Locations
  • Archives of Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Funders
  • National Institutes of Health (5p30ag008017-30, 5r01ag011378-25)
  • National Institute on Aging (AG 05136, P50 AG 005136, AG008017, R01 AG023801, R01-AG011378, U01 AG006781, R37AG011378, P30-AG008017, AG-11378, R01AG017155, AG-06781)
  • National Institute of Neurological Disorders and Stroke (P50NS062684, NS62684)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
Keywords
Alzheimer's disease, cognitively normal older adults, neuritic plaques, neurofibrillary tangles, cerebral microinfarcts, Lewy bodies, neuropathology, comorbidities, brain aging
MeSH terms
Aged, Aged, 80 and over, Aging, Alzheimer Disease, Brain, Female, Hawaii, Humans, Male, Oregon, Dementia, Vascular, Cohort Studies, Prevalence, Lewy Body Disease

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