ePrints

Epidemiological pathology of dementia: Attributable-risks at death in the medical research council cognitive function and ageing study

Lookup NU author(s): Professor Carol Brayne, Professor Ian McKeith

Downloads

• Published version [.pdf]

Abstract

Background: Dementia drug development aims to modulate pathological processes that cause clinical syndromes. Population data (epidemiological neuropathology) will help to model and predict the potential impact of such therapies on dementia burden in older people. Presently this can only be explored through post mortem findings. We report the attributable risks (ARs) for dementia at death for common age-related degenerative and vascular pathologies, and other factors, in the MRC Cognitive Function and Ageing Study (MRC CFAS). Methods and Findings: A multicentre, prospective, longitudinal study of older people in the UK was linked to a brain donation programme. Neuropathology of 456 consecutive brain donations assessed degenerative and vascular pathologies. Logistic regression modelling, with bootstrapping and sensitivity analyses, was used to estimate AR at death for dementia for specific pathologies and other factors. The main contributors to AR at death for dementia in MRC CFAS were age (18%), small brain (12%), neocortical neuritic plaques (8%) and neurofibrillary tangles (11%), small vessel disease (12%), multiple vascular pathologies (9%), and hippocampal atrophy (10%). Other significant factors include cerebral amyloid angiopathy (7%) and Lewy bodies (3%). Conclusions:Such AR estimates cannot be derived from the living population; rather they estimate the relative contribution of specific pathologies to dementia at death. We found that multiple pathologies determine the overall burden of dementia. The impact of therapy targeted to a specific pathology may be profound when the dementia is relatively "pure," but may be less impressive for the majority with mixed disease, and in terms of the population. These data justify a range of strategies, and combination therapies, to combat the degenerative and vascular determinants of cognitive decline and dementia. © 2009 Matthews et al.

Publication metadata

Author(s): Matthews F, Brayne C, Lowe J, McKeith I, Wharton S, Ince P

Publication type: Article

Publication status: Published

Journal: PLoS Medicine

Year: 2009

Volume: 6

Issue: 11

Date deposited: 07/11/2011

ISSN (print): 1549-1277

ISSN (electronic): 1549-1676

Publisher: Public Library of Science

URL: http://dx.doi.org/10.1371/journal.pmed.1000180

DOI: 10.1371/journal.pmed.1000180

PubMed id: 19901977

Altmetrics

Funding

Share