What have we learned from cognition in the oldest-old.

Purpose of reviewPeople over 90 are the fastest growing segment of the population with the highest rates of dementia. This review highlights recent findings that provide insight to our understanding of dementia and cognition at all ages.Recent findingsRisk factors for Alzheimer's disease (AD) and dementia differ by age, with some factors, like the development of hypertension, actually becoming protective in the oldest-old. At least half of all dementia in this age group is due to non AD pathologies, including microinfarcts, hippocampal sclerosis and TDP-43. The number of pathologic changes found in the brain is related to both risk and severity of dementia, but many people in this age group appear to be 'resilient' to these pathologies. Resilience to Alzheimer pathology, in part, may be related to absence of other pathologies, and imaging and spinal fluid biomarkers for AD have limited utility in this age group.SummaryStudies of dementia in the oldest-old are important for our understanding and eventual treatment or prevention of dementia at all ages

What have we learned from cognition in the oldest-old.

Purpose of reviewPeople over 90 are the fastest growing segment of the population with the highest rates of dementia. This review highlights recent findings that provide insight to our understanding of dementia and cognition at all ages.Recent findingsRisk factors for Alzheimer's disease (AD) and dementia differ by age, with some factors, like the development of hypertension, actually becoming protective in the oldest-old. At least half of all dementia in this age group is due to non AD pathologies, including microinfarcts, hippocampal sclerosis and TDP-43. The number of pathologic changes found in the brain is related to both risk and severity of dementia, but many people in this age group appear to be 'resilient' to these pathologies. Resilience to Alzheimer pathology, in part, may be related to absence of other pathologies, and imaging and spinal fluid biomarkers for AD have limited utility in this age group.SummaryStudies of dementia in the oldest-old are important for our understanding and eventual treatment or prevention of dementia at all ages

Rekanalisatie na occlusie van A. carotis interna

Background: In patients who have suffered a transient ischemic attack (TIA) or ischaemic stroke, diagnostic imaging often reveals an occlusion in the extracranial internal carotid artery (ICA) on the symptomatic side. It is generally assumed that no follow-up is needed. Case description: A 57-year-old man reported to the emergency department with global aphasia. Two weeks previously he had been diagnosed with an occlusion of the left ICA following a TIA. On the basis of CT angiography we diagnosed an ischaemic stroke in the left middle cerebral artery territory and a severe stenosis of the left ICA. Several days later the patient underwent a successful carotid endarterectomy. Conclusion: Following an acute symptomatic occlusion of the extracranial ICA, recanalisation of the artery can take place. In these patients we advise considering a repeat of the diagnostic imaging of the ICA within a week

White Matter Hyperintensities and Hippocampal Atrophy in Relation to Cognition: The 90+Study

Abstract Objective: To study the interactive effect of white matter hyperintensities (WMH) and hippocampal atrophy on cognition in the oldest-old. Background: Cognitive functioning in individuals aged 90 years and older (the oldest-old) is determined by multiple factors. The association between cognitive impairment and individual pathologies seems to become weaker at older ages. It remains however unknown how these different pathologies interact in the oldest-old. Design/Methods: Participants were 141 individuals (94 cognitively normal and 47 cognitively impaired). Each participant completed a brain MRI scan. Cognitive testing was performed every six months with a mean follow-up of 2.0 years and included the following tests: Mini-Mental State Examination (MMSE), modified MMSE (3MS), California Verbal Learning Test (CVLT) immediate recall over four trials and delayed recall, Digit Span Backward, Animal Fluency, Trail Making Test (TMT) A, B and C. One linear mixed model was used for each cognitive test to study the baseline and longitudinal association of WMH and hippocampal volume with cognition. Models were adjusted for age, gender and education. Results: Mean age of the study sample was 94.3 (SD=3.2) years. At baseline, higher WMH volumes were associated with worse scores on the 3MS, CVLT immediate and delayed recall and TMT B. Lower hippocampal volumes were associated with worse baseline scores on all cognitive tests, except for the Digit Span Backward. Longitudinally, higher WMH and lower hippocampal volumes were associated with faster decline in the 3MS and MMSE and lower hippocampal volume was also associated with faster decline in the CVLT immediate recall. There was no association between WMH and hippocampal volume and no interaction between WMH and hippocampal volume in their association with baseline cognition or cognitive decline. Conclusions: The research shows that WMH and hippocampal atrophy have an independent, and not synergistic, negative effect on cognition in the oldest-old

The association of vascular disorders with incident dementia in different age groups

10.1186/s13195-019-0496-xALZHEIMERS RESEARCH & THERAPY11

AMYLOID-β IS ASSOCIATED WITH THINNER CORTEX IN COGNITIVELY NORMAL OLDEST-OLD INDIVIDUALS

Background: Previous autopsy studies have demonstrated a high prevalence of widespread Alzheimer's disease (AD) pathology in individuals without dementia at high ages (>85y), which has raised doubts on the relationship of amyloid-β (Aβ) with dementia. In younger elderly (60-80y) without cognitive impairment, Aβ accumulation has been associated with subtle cognitive changes and cortical thinning. However, it remains unclear whether Aβ accumulation in oldest-old individuals with normal cognition is associated with changes in brain structure and cognitive functioning. We studied this using data from the EMIF-AD 90+ study. Methods: We selected 61 cognitively normal (CN) individuals from the EMIF-AD 90+ study, with available amyloid positron emission tomography (PET), and structural magnetic resonance imaging (MRI). Visual rating of the amyloid PET scan was used to classify the subjects as CN Aβ- (n=34) or CN Aβ+ (n=27). Cognitive performance on the Logical Delayed Memory test and MMSE were compared between groups. Subcortical volumes and cortical thickness measures in each ROI of FreeSurfer's Desikan-Killany atlas were calculated from 3T 3D-T1 images, and compared between groups using general linear models with Bonferroni correction and adjusted for age, and sex. Results: The individuals had a mean age of 93 years (range 88-102y), and 44% were rated as Aβ+. CN Aβ+ individuals had lower, but non-significant, memory scores and worse MMSE scores compared to the Aβ- group (Table1). Moreover, compared to the Aβ- group, CN individuals with Aβ+ showed thinner parahippocampal, rostral anterior cingulate, medial orbitofrontal, fusiform, superior temporal cortex, and smaller amygdala volume (pBonferron

White Matter Hyperintensities and Hippocampal Atrophy in Relation to Cognition: The 90+ Study

OBJECTIVES: To study the interactive effect of white matter hyperintensities (WMH) and hippocampal atrophy on cognition in the oldest old. DESIGN: Ongoing longitudinal study. SETTING: In Southern California, brain magnetic resonance imaging (MRI) scans were conducted between May 2014 and December 2017. PARTICIPANTS: Individuals from The 90+ Study with a valid brain MRI scan (N = 141; 94 cognitively normal and 47 with cognitive impairment). MEASUREMENTS: Cognitive testing was performed every 6 months with a mean follow-up of 2 years and included these tests: Mini-Mental State Examination (MMSE), modified MMSE (3MS), California Verbal Learning Test (CVLT) immediate recall over four trials and delayed recall, Digit Span Backward, Animal Fluency, and Trail Making Test (TMT) A, B, and C. We used one linear mixed model for each cognitive test to study the baseline and longitudinal association of WMH and hippocampal volume (HV) with cognition. Models were adjusted for age, sex, and education. RESULTS: Mean age was 94.3 years (standard deviation [SD] = 3.2 y). At baseline, higher WMH volumes were associated with worse scores on the 3MS, CVLT immediate and delayed recall, and TMT B. Lower HVs were associated with worse baseline scores on all cognitive tests, except for the Digit Span Backward. Longitudinally, higher WMH and lower HVs were associated with faster decline in the 3MS and MMSE, and lower HV was also associated with faster decline in the CVLT immediate recall. No association was observed between WMH and HV and no interaction between WMH and HV in their association with baseline cognition or cognitive decline. CONCLUSION: We show that WMH and hippocampal atrophy have an independent, negative effect on cognition that make these biomarkers relevant to evaluate in the diagnostic work-up of the oldest-old individuals with cognitive complaints. However, the predictive value of WMH for cognitive decline seems to be less evident in the oldest-old compared with a younger group of older adults. J Am Geriatr Soc 67:1827–1834, 2019

White matter hyperintensities are related to pain intensity in an outpatient memory clinic population: preliminary findings

10.2147/JPR.S158488JOURNAL OF PAIN RESEARCH121621-162