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Neuropathological diagnoses and clinical correlates in older adults in Brazil: A cross-sectional study

BACKGROUND: Clinicopathological studies are important in determining the brain lesions underlying dementia. Although almost 60% of individuals with dementia live in developing countries, few clinicopathological studies focus on these individuals. We investigated the frequency of neurodegenerative an...

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Autores principales: Suemoto, Claudia K., Ferretti-Rebustini, Renata E. L., Rodriguez, Roberta D., Leite, Renata E. P., Soterio, Luciana, Brucki, Sonia M. D., Spera, Raphael R., Cippiciani, Tarcila M., Farfel, Jose M., Chiavegatto Filho, Alexandre, Naslavsky, Michel Satya, Zatz, Mayana, Pasqualucci, Carlos A., Jacob-Filho, Wilson, Nitrini, Ricardo, Grinberg, Lea T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369698/
https://www.ncbi.nlm.nih.gov/pubmed/28350821
http://dx.doi.org/10.1371/journal.pmed.1002267
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author Suemoto, Claudia K.
Ferretti-Rebustini, Renata E. L.
Rodriguez, Roberta D.
Leite, Renata E. P.
Soterio, Luciana
Brucki, Sonia M. D.
Spera, Raphael R.
Cippiciani, Tarcila M.
Farfel, Jose M.
Chiavegatto Filho, Alexandre
Naslavsky, Michel Satya
Zatz, Mayana
Pasqualucci, Carlos A.
Jacob-Filho, Wilson
Nitrini, Ricardo
Grinberg, Lea T.
author_facet Suemoto, Claudia K.
Ferretti-Rebustini, Renata E. L.
Rodriguez, Roberta D.
Leite, Renata E. P.
Soterio, Luciana
Brucki, Sonia M. D.
Spera, Raphael R.
Cippiciani, Tarcila M.
Farfel, Jose M.
Chiavegatto Filho, Alexandre
Naslavsky, Michel Satya
Zatz, Mayana
Pasqualucci, Carlos A.
Jacob-Filho, Wilson
Nitrini, Ricardo
Grinberg, Lea T.
author_sort Suemoto, Claudia K.
collection PubMed
description BACKGROUND: Clinicopathological studies are important in determining the brain lesions underlying dementia. Although almost 60% of individuals with dementia live in developing countries, few clinicopathological studies focus on these individuals. We investigated the frequency of neurodegenerative and vascular-related neuropathological lesions in 1,092 Brazilian admixed older adults, their correlation with cognitive and neuropsychiatric symptoms, and the accuracy of dementia subtype diagnosis. METHODS AND FINDINGS: In this cross-sectional study, we describe clinical and neuropathological variables related to cognitive impairment in 1,092 participants (mean age = 74 y, 49% male, 69% white, and mean education = 4 y). Cognitive function was investigated using the Clinical Dementia Rating (CDR) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); neuropsychiatric symptoms were evaluated using the Neuropsychiatric Inventory (NPI). Associations between neuropathological lesions and cognitive impairment were investigated using ordinal logistic regression. We developed a neuropathological comorbidity (NPC) score and compared it to CDR, IQCODE, and NPI scores. We also described and compared the frequency of neuropathological diagnosis to clinical diagnosis of dementia subtype. Forty-four percent of the sample met criteria for neuropathological diagnosis. Among these participants, 50% had neuropathological diagnoses of Alzheimer disease (AD), and 35% of vascular dementia (VaD). Neurofibrillary tangles (NFTs), hippocampal sclerosis, lacunar infarcts, hyaline atherosclerosis, siderocalcinosis, and Lewy body disease were independently associated with cognitive impairment. Higher NPC scores were associated with worse scores in the CDR sum of boxes (β = 1.33, 95% CI 1.20–1.46), IQCODE (β = 0.14, 95% CI 0.13–0.16), and NPI (β = 1.74, 95% CI = 1.33–2.16). Compared to neuropathological diagnoses, clinical diagnosis had high sensitivity to AD and high specificity to dementia with Lewy body/Parkinson dementia. The major limitation of our study is the lack of clinical follow-up of participants during life. CONCLUSIONS: NFT deposition, vascular lesions, and high NPC scorewere associated with cognitive impairment in a unique Brazilian sample with low education. Our results confirm the high prevalence of neuropathological diagnosis in older adults and the mismatch between clinical and neuropathological diagnoses.
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spelling pubmed-53696982017-04-06 Neuropathological diagnoses and clinical correlates in older adults in Brazil: A cross-sectional study Suemoto, Claudia K. Ferretti-Rebustini, Renata E. L. Rodriguez, Roberta D. Leite, Renata E. P. Soterio, Luciana Brucki, Sonia M. D. Spera, Raphael R. Cippiciani, Tarcila M. Farfel, Jose M. Chiavegatto Filho, Alexandre Naslavsky, Michel Satya Zatz, Mayana Pasqualucci, Carlos A. Jacob-Filho, Wilson Nitrini, Ricardo Grinberg, Lea T. PLoS Med Research Article BACKGROUND: Clinicopathological studies are important in determining the brain lesions underlying dementia. Although almost 60% of individuals with dementia live in developing countries, few clinicopathological studies focus on these individuals. We investigated the frequency of neurodegenerative and vascular-related neuropathological lesions in 1,092 Brazilian admixed older adults, their correlation with cognitive and neuropsychiatric symptoms, and the accuracy of dementia subtype diagnosis. METHODS AND FINDINGS: In this cross-sectional study, we describe clinical and neuropathological variables related to cognitive impairment in 1,092 participants (mean age = 74 y, 49% male, 69% white, and mean education = 4 y). Cognitive function was investigated using the Clinical Dementia Rating (CDR) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); neuropsychiatric symptoms were evaluated using the Neuropsychiatric Inventory (NPI). Associations between neuropathological lesions and cognitive impairment were investigated using ordinal logistic regression. We developed a neuropathological comorbidity (NPC) score and compared it to CDR, IQCODE, and NPI scores. We also described and compared the frequency of neuropathological diagnosis to clinical diagnosis of dementia subtype. Forty-four percent of the sample met criteria for neuropathological diagnosis. Among these participants, 50% had neuropathological diagnoses of Alzheimer disease (AD), and 35% of vascular dementia (VaD). Neurofibrillary tangles (NFTs), hippocampal sclerosis, lacunar infarcts, hyaline atherosclerosis, siderocalcinosis, and Lewy body disease were independently associated with cognitive impairment. Higher NPC scores were associated with worse scores in the CDR sum of boxes (β = 1.33, 95% CI 1.20–1.46), IQCODE (β = 0.14, 95% CI 0.13–0.16), and NPI (β = 1.74, 95% CI = 1.33–2.16). Compared to neuropathological diagnoses, clinical diagnosis had high sensitivity to AD and high specificity to dementia with Lewy body/Parkinson dementia. The major limitation of our study is the lack of clinical follow-up of participants during life. CONCLUSIONS: NFT deposition, vascular lesions, and high NPC scorewere associated with cognitive impairment in a unique Brazilian sample with low education. Our results confirm the high prevalence of neuropathological diagnosis in older adults and the mismatch between clinical and neuropathological diagnoses. Public Library of Science 2017-03-28 /pmc/articles/PMC5369698/ /pubmed/28350821 http://dx.doi.org/10.1371/journal.pmed.1002267 Text en © 2017 Suemoto et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Suemoto, Claudia K.
Ferretti-Rebustini, Renata E. L.
Rodriguez, Roberta D.
Leite, Renata E. P.
Soterio, Luciana
Brucki, Sonia M. D.
Spera, Raphael R.
Cippiciani, Tarcila M.
Farfel, Jose M.
Chiavegatto Filho, Alexandre
Naslavsky, Michel Satya
Zatz, Mayana
Pasqualucci, Carlos A.
Jacob-Filho, Wilson
Nitrini, Ricardo
Grinberg, Lea T.
Neuropathological diagnoses and clinical correlates in older adults in Brazil: A cross-sectional study
title Neuropathological diagnoses and clinical correlates in older adults in Brazil: A cross-sectional study
title_full Neuropathological diagnoses and clinical correlates in older adults in Brazil: A cross-sectional study
title_fullStr Neuropathological diagnoses and clinical correlates in older adults in Brazil: A cross-sectional study
title_full_unstemmed Neuropathological diagnoses and clinical correlates in older adults in Brazil: A cross-sectional study
title_short Neuropathological diagnoses and clinical correlates in older adults in Brazil: A cross-sectional study
title_sort neuropathological diagnoses and clinical correlates in older adults in brazil: a cross-sectional study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369698/
https://www.ncbi.nlm.nih.gov/pubmed/28350821
http://dx.doi.org/10.1371/journal.pmed.1002267
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