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

Matthew, F.E., Brayne, C., Lowe, J., McKeith, I., Wharton, S.B. and Ince, P. (2009) Epidemiological pathology of dementia: attributable-risks at death in the medical research council cognitive function and ageing study. PLOS Medicine , 6 (11). Art no.e1000180 . ISSN 1549-1277

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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.

Item Type: Article
Copyright, Publisher and Additional Information: © 2009 Matthews et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Alzheimers-Disease; White-Matter; MRC CFA; Population; Diagnosis; England; Brain; Wales; Consortium; Infarcts
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine (Sheffield)
Depositing User: Miss Anthea Tucker
Date Deposited: 09 Dec 2009 12:31
Last Modified: 08 Feb 2013 16:59
Published Version: http://dx.doi.org/10.1371/journal.pmed.1000180
Status: Published
Publisher: Public Library Science
Refereed: Yes
Identification Number: 10.1371/journal.pmed.1000180
URI: http://eprints.whiterose.ac.uk/id/eprint/10241

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