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The Neuropathology of Older Persons with and Without Dementia from Community versus Clinic Cohorts
Open accessAbstract
Community-based cohorts of older persons may differ neuropathologically from clinic-based cohorts. This study investigated age-related pathologies in persons with and without dementia and included autopsied participants from two community-based cohorts, the Rush Religious Orders Study (n=386) and the Memory and Aging Project (n=195), and one clinic-based cohort, the Clinical Core of the Rush Alzheimer's Disease Center (n=392). Final clinical diagnoses included no cognitive impairment (n=202), mild cognitive impairment (MCI) (n=150), probable Alzheimer's disease (AD) (n=474), possible AD (n=88), and other dementias (n=59). Postmortem diagnoses included pathologic AD, cerebral infarcts, and Lewy body disease. Community-based persons with clinical AD had less severe AD pathology (p<0.001) and had more cerebral infarcts (p<0.001) compared to clinic-based persons. Additionally, community-based persons with MCI had more infarcts compared to clinic-based persons. Overall, there was a higher proportion of Lewy bodies and atypical pathologies in the clinic-based compared to the community-based cohorts (p<0.001). Community-based persons with probable AD show less severe AD pathology and more often have infarcts and mixed pathologies; those with MCI more often have infarcts and mixed pathologies. Overall, clinic-based persons have more Lewy bodies and atypical pathologies. The spectrum of pathologies underlying cognitive impairment in clinic-based cohorts differs from community-based cohorts.
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“typically are accompanied by Alzheimer disease and other pathologies.”
From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [54]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Chronic macroscopic infarcts are very common, occurring in approximately one third to one half of older people,13,54–56 a frequency far greater than the frequency of clinical stroke.”
From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [54]
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“occur commonly in older people with and without dementia”
From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [54]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
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“Infarcts frequently coexist with Alzheimer disease pathology in the brains of older people.”
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“It is widely recognized that clinic-based participants differ from community-based studies, for example, the amount, type, and distribution of neuropathologic changes differ by the source of a participant [206,207].”
From NIA‐AA Research Framework: Toward a biological definition of Alzheimer's disease (2018) · cites this paper as [206]
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“First, it captures all the factors affecting cognition, including diverse pathologies as well as biological mechanisms independent of pathologies4–6.”
From Large-scale proteomic analysis of human brain identifies proteins associated with cognitive trajectory in advanced age (2019) · cites this paper as [4]
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“Second, it likely captures co-occurring disease processes and co-occurring age-related pathologies, which are known to be prevalent in the brains of aged individuals4,5.”
From Large-scale proteomic analysis of human brain identifies proteins associated with cognitive trajectory in advanced age (2019) · cites this paper as [4]
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“For example, because persons with behavioral problems are more likely to require help than those with isolated memory problems, the prevalence and types of Lewy body disease derived from a clinic are likely to be different from those from a broader community (11).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [11]
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“In autopsy series associated with dementia clinics, a higher proportion of non-AD tauopathies are seen, presumably due to recruitment bias (111).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [111]
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“In most community-based autopsy series, non-AD tauopathies constitute approximately 1% of dementia cases (108-115) (but see Noda et al [116]).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [111]
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Metadata
- Authors
- Schneider, J. A., Aggarwal, N. T., Barnes, L., Boyle, P., & Bennett, D. A.
- Affiliations
- Rush University Medical Center (US)
- Corresponding author
- Schneider, Julie A.
- Venue
- Journal of Alzheimer's Disease
- Publisher
- SAGE Publications
- Published
- 2009-10-30
- Volume
- 18
- Issue
- 3
- Pages
- 691-701
- ISSN
- 1387-2877 (ISSN-L)
- 1875-8908
- PMC
- PMC2853869
- OpenAlex
- W1548995643
- Cited by
- 372
- References
- 34
- Citations by year
- 2026: 27 · 2025: 28 · 2024: 24 · 2023: 16 · 2022: 27 · 2021: 21 · 2020: 19 · 2019: 20 · 2018: 20 · 2017: 24 · 2016: 24 · 2015: 17 · 2014: 18 · 2013: 24 · 2012: 18
- FWCI
- 12.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Alzheimer s Disease (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG017917, K08 AG00849, P30-AG 10161, R01‐AG17917, R01 AG15819, R01AG015819, P30AG010161, K08AG000849, R01AG022018)
- National Institute of Neurological Disorders and Stroke
- 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
- neuropathology, dementia
- MeSH terms
- Aged, Aging, Alzheimer Disease, Cognition Disorders, Community Health Services, Dementia, Humans, Memory Disorders, Neuropsychological Tests, Severity of Illness Index, Tissue Donors, Cohort Studies
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