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Scholarly Works (5 results)

  • Article
  • Peer Reviewed
UC Irvine Previously Published Works (2007)

Background

The apolipoprotein E (APOE) epsilon2 allele has been suggested as having a protective effect and delaying the age at onset of Alzheimer disease.

Objective

To describe a dissociation between neuropathologic findings with normal cognition in a woman with severe Alzheimer disease with the APOE epsilon2/epsilon2 genotype.

Design

Case report from a community-based prospective study of persons 90 years or older (The 90+ Study).

Participant

A 92-year-old woman without dementia with the APOE epsilon2/epsilon2 genotype who lived independently without significant cognitive or functional loss and was a participant in The 90+ Study. She died in December 2004, and postmortem examination of her brain was performed.

Intervention

Neurologic examination and a battery of neuropsychological tests were performed 6 months and 1 month before death. Neuropathologic examination included Braak and Braak staging for senile plaques and neurofibrillary tangles.

Results

Neuropathologic examination of the brain revealed advanced senile plaque and neurofibrillary tangle disease consistent with a high likelihood of Alzheimer disease. At clinical evaluation, the participant demonstrated no dementia and only mild cognitive deficits.

Conclusions

The APOE genotype may have contributed to maintenance of cognition despite advanced neuropathologic findings of Alzheimer disease. This case suggests that the APOE epsilon2 isoform may have a protective effect against cognitive decline in Alzheimer disease that may be independent from senile plaques and neurofibrillary tangles.
    Cover page: Dissociation of Neuropathologic Findings and Cognition: Case Report of an Apolipoprotein E ε2/ε2 GenotypeCreative Commons 'BY' version 4.0 license
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2007)

    OBJECTIVES: To evaluate the sensitivity and specificity of the Mini-Mental State Examination (MMSE) in identifying dementia in the oldest-old when stratified by age and education. DESIGN: Cross-sectional. SETTING: Research clinic and in-home visits. PARTICIPANTS: Population-based sample of adults aged 90 and older (n=435) who are enrolled in the 90+ Study, a longitudinal, population-based study. MEASUREMENTS: Neurological examination to determine dementia diagnosis, MMSE, and demographic data. RESULTS: Receiver operating characteristic (ROC) analyses indicated that the MMSE had high diagnostic accuracy for identifying dementia in subjects aged 90 and older across different age and education groups (area under the ROC curve values ranged from 0.82 to 0.98). A range of possible cutoff values and corresponding sensitivity and specificity are provided for the following age groups: 90-93, 94-96, and >= 97. Age groups were subdivided by educational attainment (<= high school, vocational school or some college, college degree or higher). In subjects aged 90 to 93 with a college degree or higher, the suggested MMSE cutoff score is <= 25 (sensitivity=0.82, specificity=0.80). In those aged 94 to 96 with a college degree or higher, the suggested cutoff is <= 24 (sensitivity=0.85, specificity=0.80). Those aged 97 and older with an education of high school or less had the lowest suggested cutoff <= 22 (sensitivity=0.80, specificity=0.76). CONCLUSION: Overall, the MMSE had good sensitivity and specificity across all age and educational groups. Optimal cutoff points were lower in the older age groups and those with less education, primarily to preserve specificity. This screening instrument is appropriate for use with the oldest-old.

      Cover page: Sensitivity and specificity of the Mini-Mental State Examination for identifying dementia in the oldest-old: The 90+study
      • Peer Reviewed
      UC Irvine Previously Published Works (2009)
      Introduction Fueled by medical and technological advances, average life expectancy in the USA has increased by more than 25 years over the past century. A consequence of increased longevity and the aging of the “baby boomers” is that the oldest-old (age 90 or older) have become the fastest growing segment of the US population. Currently, there are fewer than 2 million Americans aged 90 and older, but this number will increase to approximately 10 million by 2050. In terms of percentage of the population, those aged 90 and older presently represent 0.5% of the population in the USA, while by the middle of the twenty-first century, they will form about 2.5% of the population as depicted in Fig. 17.1. Moreover, the increases in the oldest-old population are occurring worldwide. Countries including Japan, France, Italy and Germany are expected to have between 3 and 5% of their population aged 90 and over by 2050. Cognition in the oldest-old: key questions What is the prevalence of dementia in the oldest-old? What are the causes of dementia in the oldest-old? How can we screen for dementia in this population and what challenges must we overcome in the cognitive assessment of this age group? What are the clinical–pathological correlates of dementia in the oldest-old? The rapidly growing population over the age of 90 signals a need to understand aging and age-related conditions in the oldest-old. Many issues require investigation in these pioneers of aging. Estimates of dementia prevalence vary as described in more detail below.
        Cover page: Dementia and cognition in the oldest-oldCreative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2007)

        Although the oldest old are the fastest growing segment of the population, little is known about their cognitive performance. Our aim was to compile a relatively brief test battery that could be completed by a majority of individuals aged 90 or over, compensates for sensory losses, and incorporates previously validated, standardized, and accessible instruments. Means, standard deviations, and percentiles for 10 neuropsychological tests covering multiple cognitive domains are reported for 339 nondemented members of the 90+ Study. Cognitive performance declined with age for two-thirds of the tests. Performance on some tests was also affected by gender, education, and depression scores.

          Cover page: Neuropsychological data in nondemented oldest old: the 90+ Study.
          • Article
          • Peer Reviewed
          UC Irvine Previously Published Works (2009)
          An increasing number of individuals in our population are surviving to over 90 years and a subset is at risk for developing dementia. However, senile plaque and neurofibrillary tangle pathology do not consistently differentiate individuals with and without dementia. Synaptic protein loss is a feature of aging and dementia and may dissociate 90+ individuals with and without dementia. Synaptophysin (SYN), postsynaptic density 95 (PSD-95) and growth-associated protein 43 (GAP-43) were studied in the frontal cortex of an autopsy series of 32 prospectively followed individuals (92-105 years) with a range of cognitive function. SYN protein levels were decreased in individuals with dementia and increased in those with clinical signs of cognitive impairment insufficient for a diagnosis of dementia. SYN but neither PSD-95 nor GAP-43 protein levels were significantly correlated with mini-mental status examination (MMSE) scores. Frontal cortex SYN protein levels may protect neuronal function in oldest-old individuals and reflect compensatory responses that may be involved with maintaining cognition.
            Cover page: Synaptic proteins, neuropathology and cognitive status in the oldest-oldCreative Commons 'BY' version 4.0 license
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