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August 11, 2015; 85 (6) Article

Mixed pathology is more likely in black than white decedents with Alzheimer dementia

Lisa L. Barnes, Sue Leurgans, Neelum T. Aggarwal, Raj C. Shah, Zoe Arvanitakis, Bryan D. James, Aron S. Buchman, David A. Bennett, Julie A. Schneider
First published July 15, 2015, DOI: https://doi.org/10.1212/WNL.0000000000001834
Lisa L. Barnes
From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
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Sue Leurgans
From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
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Neelum T. Aggarwal
From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
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Raj C. Shah
From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
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Zoe Arvanitakis
From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
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Bryan D. James
From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
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Aron S. Buchman
From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
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David A. Bennett
From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
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Julie A. Schneider
From Rush Alzheimer's Disease Center (L.L.B., S.L., N.T.A., R.C.S., Z.A., B.D.J., A.S.B., D.A.B., J.A.S.), the Department of Neurological Sciences (L.L.B., S.L., N.T.A., Z.A., A.S.B., D.A.B., J.A.S.), the Department of Behavioral Sciences (L.L.B.), Family Medicine (R.C.S.), Internal Medicine (B.D.J.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL.
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Citation
Mixed pathology is more likely in black than white decedents with Alzheimer dementia
Lisa L. Barnes, Sue Leurgans, Neelum T. Aggarwal, Raj C. Shah, Zoe Arvanitakis, Bryan D. James, Aron S. Buchman, David A. Bennett, Julie A. Schneider
Neurology Aug 2015, 85 (6) 528-534; DOI: 10.1212/WNL.0000000000001834

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Abstract

Objective: To compare the burden of neuropathology in black and white participants with clinical Alzheimer disease (AD).

Methods: Participants included 122 persons enrolled in the Rush Alzheimer's Disease Clinical Core, a prospective cohort study of AD. Forty-one black decedents were matched two-to-one to 81 white decedents according to age at death, sex, years of education, and cognition proximate to death. We examined common brain pathologies related to dementia (AD, Lewy body, and macroscopic and microinfarct pathology) and arteriolar sclerosis and atherosclerosis. We calculated the frequency of each dementia pathology both alone and in combination (mixed pathologies). Racial differences in the odds of a single pathology vs mixed pathologies, and in the odds of vessel disease and its severity, were examined using logistic regression analyses.

Results: AD pathology was confirmed in >93% of both black and white decedents with AD dementia. However, black decedents were less likely to have Alzheimer pathology as a single dementia pathology than white decedents (19.5% vs 42.0%), and were more likely to have AD mixed with an additional pathology (70.7% vs 50.6%), particularly Alzheimer pathology and Lewy bodies, and Alzheimer pathology, Lewy bodies, and infarcts. Black decedents also had more severe arteriolar sclerosis and atherosclerosis.

Conclusion: Black decedents with AD dementia are more likely to have mixed brain pathologies compared with age-, sex-, education-, and cognition-matched white decedents with AD dementia.

GLOSSARY

AD=
Alzheimer disease;
CERAD=
Consortium to Establish a Registry for Alzheimer's Disease;
MMSE=
Mini-Mental State Examination;
OR=
odds ratio;
PMI=
postmortem interval

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received December 23, 2014.
  • Accepted in final form April 14, 2015.
  • © 2015 American Academy of Neurology
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