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Recent Clinical-Pathologic Research on the Causes of Dementia in Late Life: Update From the Honolulu-Asia Aging Study

Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, Departments of Geriatric Medicine and Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, Honolulu Department of Veterans Affairs, Honolulu, HI, lrwhite{at}phrihawaii.org

Brent J. Small, PhD

School of Aging Studies, University of South Florida, Tampa, FL

Helen Petrovitch, MD

Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, Departments of Geriatric Medicine and Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, Honolulu Department of Veterans Affairs, Honolulu, HI

G. Webster Ross, MD

Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, Departments of Geriatric Medicine and Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, Honolulu Department of Veterans Affairs, Honolulu, HI

Kamal Masaki, MD

Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, Departments of Geriatric Medicine and Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, Honolulu Department of Veterans Affairs, Honolulu, HI

Robert D. Abbott, PhD

Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, Departments of Geriatric Medicine and Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, Honolulu Department of Veterans Affairs, Honolulu, HI, University of Virginia School of Medicine, Charlottesville, VA

John Hardman, MD

Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, Departments of Geriatric Medicine and Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, Honolulu Department of Veterans Affairs, Honolulu, HI

Daron Davis, MD

University of Virginia School of Medicine, Charlottesville, VA

James Nelson, MD

Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, HI, Departments of Geriatric Medicine and Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, Honolulu Department of Veterans Affairs, Honolulu, HI

William Markesbery, MD

Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY

In this study, we compare neuropathological findings at autopsy with clinical dementia diagnoses, such as Alzheimer’s disease and vascular dementia. Participants consisted of 363 aged Japanese-American men from the Honolulu-Asia Aging Study. Results indicated that the correspondence between clinical and neuropathologic diagnosis was not great, with 56% of patients diagnosed with probable or possible Alzheimer’s disease during life but with only 19% having neuritic plaques and/or neurofibrillary tangles as the sole or dominant dementia-related lesions in the brain at autopsy. Although 16% of cases were attributed to mixed causes during life, almost 40% were found to have significant mixtures of dementia-related lesions at autopsy. Finally, both Alzheimer’s disease and non-Alzheimer’s disease neuropathologic lesions contributed independently to the explanation of variance on a test of overall cognitive performance. The results suggest that clinical diagnosis of dementia made during life may fail to reflect the pathogenic complexity of this condition in very elderly persons.

Key Words: Alzheimer’s disease • neuropathological criteria • clinical diagnosis

Journal of Geriatric Psychiatry and Neurology, Vol. 18, No. 4, 224-227 (2005)
DOI: 10.1177/0891988705281872


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