Cancer and Vascular Comorbidity Effects on Dementia Risk and Neuropathology in the Oldest-Old.
J Alzheimers Dis
; 90(1): 405-417, 2022.
Article
in En
| MEDLINE
| ID: mdl-36213996
ABSTRACT
BACKGROUND:
Dementia, vascular disease, and cancer increase with age, enabling complex comorbid interactions. Understanding vascular and cancer contributions to dementia risk and neuropathology in oldest-old may improve risk modification and outcomes.OBJECTIVE:
Investigate the contributions of vascular factors and cancer to dementia and neuropathology.METHODS:
Longitudinal clinicopathologic study of prospectively followed Mayo Clinic participants dying≥95 years-old who underwent autopsy. Participants were stratified by dementia status and compared according to demographics, vascular risk factors, cancer, and neuropathology.RESULTS:
Participants (nâ=â161; 83% female; 99% non-Hispanic whites)≥95 years (95-106 years-old) with/without dementia did not differ based on demographics. APOE É2 frequency was higher in no dementia (20/72 [28%]) versus dementia (11/88 [12%]; pâ=â0.03), but APOE É4 frequency did not differ. Coronary artery disease was more frequent in no dementia (31/72 [43%]) versus dementia (23/89 [26%]; pâ=â0.03) associated with 56% lower dementia odds (odds ratio [OR]â=â0.44 [confidence interval (CI)â=â0.19-0.98]; pâ=â0.04) and fewer neuritic/diffuse plaques. Diabetes had an 8-fold increase in dementia odds (ORâ=â8.42 [CIâ=â1.39-163]; pâ=â0.02). Diabetes associated with higher cerebrovascular disease (Dickson score; pâ=â0.05). Cancer associated with 63% lower dementia odds (ORâ=â0.37 [CIâ=â0.17-0.78]; pâ<â0.01) and lower Braak stage (pâ=â0.01).CONCLUSION:
Cancer exposure in the oldest-old was associated with lower odds of dementia and tangle pathology, whereas history of coronary artery disease was associated with lower odds of dementia and amyloid-ß plaque pathology. History of diabetes mellitus was associated with increased odds of dementia and cerebrovascular disease pathology. Cancer-related mechanisms and vascular risk factor reduction strategies may alter dementia risk and neuropathology in oldest-old.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Coronary Artery Disease
/
Cerebrovascular Disorders
/
Diabetes Mellitus
/
Alzheimer Disease
/
Neoplasms
/
Nervous System Diseases
Type of study:
Etiology_studies
/
Risk_factors_studies
Limits:
Aged80
/
Female
/
Humans
/
Male
Language:
En
Journal:
J Alzheimers Dis
Journal subject:
GERIATRIA
/
NEUROLOGIA
Year:
2022
Document type:
Article
Affiliation country:
Estados Unidos