nacc data in the news

NACC data used in two noteworthy studies

Neurology Today has released a list, chosen by its expert editorial advisory board, of the year's 17 most important advances in a range of subject areas, from health policy to neurogenetics to Parkinson's disease. Of the three advances that related to Alzheimer's disease, two utilized NACC neuropathology data.

ONE STUDY, published in Neurology (Neurology 2013;80(23):2121-2129) looked at the autopsies of subjects with and without symptoms of Alzheimer's disease who proved to have varying degrees of AD neuropathologic change. Among the findings, expression of AD symptoms was affected more by neurofibrillary tangle scores than neuritic plaque burden, and symptomatic patients tended to be older, have a history of recent depression, and have higher Hachinski Ischemic Scores, suggestive of vascular dementia (although cerebrovascular pathology was not associated with symptoms). There was also an effect of apolipoprotein E (APOE) allelic status even after the amount of amyloid-beta neuropathology was taken into account.

Why it was noteworthy: In the view of the Neurology Today editorial advisory board, this finding is important because it not only provides an explanation for the pathophysiology of this gene mutation (APOE), but also suggests that there may be a new mechanism of disease at work in patients with the gene mutation.

The study was led by NACC Research Scientist Sarah Monsell, with contributions by NACC Director Walter A. Kukull, NACC faculty member Charles Mock, and researchers at the Knight ADRC at Washington University in St. Louis: John C. Morris, Catherine Roe, Nupur Ghoshal, and Nigel Cairns.

ANOTHER STUDY, published in the journal Brain, (Brain 2013; 136: 2697–2706) examined the contribution of cerebrovascular disease in confirmed neurodegenerative disease cases in the NACC database. In a series of 6205 autopsy cases of dementia, all types of dementias were found to have a vascular component, ranging from 60 percent in frontotemporal dementias to 80 percent in AD. In every case, the presence of vascular disease decreased the threshold of the presentation of dementia.

Why it was noteworthy: This study made the publication's list because vascular disease is highly treatable, and identifying the vascular component could prevent, delay, or mitigate dementia. Even a small delay in the onset would make a huge difference. For instance, delaying the onset of AD by one year would cut the prevalence by 20 percent; delaying it by five years would cut the prevalence of dementia in half.

The study was led by Jon B. Toledo of the University of Pennsylvania ADC, with contributions from Steven Arnold, Kevin Raible, Johannes Brettschneider, Sharon X. Xie, Murray Grossman, and John Q. Trojanowski, along with Sarah Monsell and Walter A. Kukull.