Alzheimer

1
Alzheimers Disease in Centenarians
Clinicopathologic Correlations in the Georgia
Centenarian Study

• Marla Gearing1, William R. Markesbery2, Leonard
  W. Poon3, Molly Burgess3, Robert C. Green4
• 1Dept. of Pathology and Laboratory Medicine and
  Alzheimers Disease Center, Emory University,
  Atlanta, GA 2Dept. of Pathology, University of
  Kentucky and Alzheimers Disease Center,
  Lexington, KY 3Gerontology Center, University of
  Georgia, Athens, GA 4Dept. of Neurology and
  Alzheimers Disease Center, Boston University,
  Boston, MA

• BACKGROUND
• The prevalence of dementia and Alzheimers
  disease (AD)
  in centenarians is poorly understood.
• In studies to date, up to 80 of centenarians
  exhibited some cognitive impairment, yet only
  40-60 met criteria for dementia or AD.
• Few prior studies of centenarians have
  included neuropathologic follow-up none have
  incorporated both antemortem neuropsychological
  testing and postmortem quantitative
  neuropathologic assessment measures with
  sufficient numbers of subjects to be meaningful.

Neurofibrillary Pathology

• SAMPLE DESCRIPTION
•  

Braak score could not be ascertained in one case.
Other Neuropathologic Findings in Centenarians
OBJECTIVE
To report our findings in the first 22 brain
donors enrolled in a project on neuropathology in
centenarians as part of the Georgia Centenarian
Study.
age at evaluation age at death, if deceased,
or current age
RESULTS
Pathology of Centenarians Number of Cases in
Each Neuropathologic Category Stratified by MMSE
Score

• METHODS
• Georgia Centenarian Study (GCS)
• In this population-based study, 244 individuals
  from 44 counties in Northern Georgia aged 98
  years or older were recruited using two sources
  1) voter registration lists and date of birth
  information, and 2) a census of all skilled
  nursing facilities and personal care homes. Each
  subject recruited was asked to undergo a series
  of interviews, physical examination, blood
  drawing, and cognitive testing. The age of each
  centenarian was verified by examination of a
  birth certificate, drivers license, Medicare
  card, or other suitable document.

• CONCLUSIONS
• Findings in the first 22 subjects suggest that
• Pathological findings meeting current
  neuropathology diagnostic criteria for AD are
  uncommon in centenarians only 4 of our 22 cases
  (18) had pathologic changes severe enough to
  warrant a neuropathologic diagnosis of AD.
• Other pathologic changes or combinations of
  changes may contribute to cognitive impairment in
  these individuals.

• Neuropathology Project
• 212 individuals were approached about brain
  donation.
• Sixty-six (31) agreed to undergo additional
  cognitive testing at 6-month intervals and donate
  their brains at death. Only MMSE scores are
  presented here the mean interval between MMSE
  and death was 3.0 months (range 0.5 to 6.0
  months).
• Race and gender of subjects enrolled in the
  Neuropathology Project generally parallel those
  of subjects enrolled in the Georgia Centenarian
  Study.

ACKNOWLEDGMENTS
One case had tiny infarcts in the posterior
pons and in the left CA1-subiculum junction,
insufficient to cause dementia the other case
had a subacute infarct in the parieto-occipital
cortex and Lewy body disease-limbic subtype.
This case had a tiny infarct in the caudate
nucleus. This case had modest numbers of
neuritic plaques and a Braak stage of II.
This study was supported by grant AG17553 from
the National Institute on Aging.