Kirsty E McAleese1, Sean J Colloby1, Alan J Thomas1, Safa Al-Sarraj2, Olaf Ansorge3, James Neal4, Federico Roncaroli5, Seth Love6, Paul T Francis2,7, Johannes Attems1. 1. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. 2. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 3. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. 4. Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK. 5. Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, Manchester University, Manchester, UK and Manchester Centre for Clinical Neuroscience, Salford Royal Foundation Trust, Salford, UK. 6. Bristol Medical School, University of Bristol, Bristol, UK. 7. College of Medicine and Health, University of Exeter, Exeter, UK.
Abstract
INTRODUCTION: The aged brain frequently exhibits multiple pathologies, rather than a single hallmark pathology (pure pathology [PurP]), ranging from low/intermediate levels of additional pathology (LowP) to mixed severe pathology (mixed SevP). We investigated the frequency of PurP, LowP, and mixed SevP, and the impact of additional LowP on cognition. METHODS: Data came from 670 cases from the Brains for Dementia research program. Cases were categorized into PurP, mixed SevP, or a main disease with additional LowP; 508 cases had a clinical dementia rating. RESULTS: 69.9% of cases had LowP, 22.7% had PurP, and 7.5% had mixed SevP. Additional LowP increased the likelihood of having mild dementia versus mild cognitive impairment (MCI) by almost 20-fold (odds ratio = 19.5). DISCUSSION: Most aged individuals have multiple brain pathologies. The presence of one additional LowP can significantly worsen cognitive decline, increasing the risk of transitioning from MCI to dementia 20-fold. Multimorbidity should be considered in dementia research and clinical studies.
INTRODUCTION: The aged brain frequently exhibits multiple pathologies, rather than a single hallmark pathology (pure pathology [PurP]), ranging from low/intermediate levels of additional pathology (LowP) to mixed severe pathology (mixed SevP). We investigated the frequency of PurP, LowP, and mixed SevP, and the impact of additional LowP on cognition. METHODS: Data came from 670 cases from the Brains for Dementia research program. Cases were categorized into PurP, mixed SevP, or a main disease with additional LowP; 508 cases had a clinical dementia rating. RESULTS: 69.9% of cases had LowP, 22.7% had PurP, and 7.5% had mixed SevP. Additional LowP increased the likelihood of having mild dementia versus mild cognitive impairment (MCI) by almost 20-fold (odds ratio = 19.5). DISCUSSION: Most aged individuals have multiple brain pathologies. The presence of one additional LowP can significantly worsen cognitive decline, increasing the risk of transitioning from MCI to dementia 20-fold. Multimorbidity should be considered in dementia research and clinical studies.
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