Strandberg, Timo E.

Tienari, Pentti J.

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Helsingin yliopiston digitaalinen arkisto

Alzheimer’s & Dementia- (2019) 1-2LetterContributions of vascular and Alzheimer’sdisease pathology to dementiaTable 1Comparison of distributions of dementia types in the systematic review [1]and the Helsinki Businessmen Study [4]Although Alzheimer’s disease (AD) is frequently cited asthe most common type of dementia, the relative contribu-tions of vascular and neurodegenerative pathology to clinicaldementia have been actually obscure. The systematic reviewof studies reporting clinicopathologic data of dementia casessheds important light on this issue [1]. Ten reports wereanalyzed, and altogether they included 2856 individuals,1544 clinically demented and 1312 nondemented, with post-mortem neuropathologic diagnosis.The results showed that both vascular-type only andAlzheimer-type only pathologies were associated withsimilar prevalence of clinical dementias, whereas the great-est risk of clinical dementia was observed among those withmixed pathologies (AD plus vascular). Neuropathologic an-alyses actually suggest that any multipathology (AD,vascular, or Lewy-related) increases the risk of dementiasignificantly [2].We have earlier sought to discern various dementia typesand their risk factors in our longitudinal study of older men(Helsinki Businessmen Study [HBS] [3]). The analyses werebased on diagnoses (not only as cause-of-death) and narra-tives in death certificates [4]. We defined as “pure” AD, ifonly AD was noted without any reference in the death certif-icate to atherosclerotic cardiovascular disease (ASCVD); aspure vascular, if dementia plus any ASCVD was noted; as“mixed” if both AD and ASCVD were mentioned in thedeath certificate. Minority of cases had other specific demen-tia diagnosis or undefined dementia without concomitantASCVD or AD.The distributions of clinicopathologic diagnoses of de-mentia types in the systematic review and clinical diagnosesin the HBS had a striking resemblance, and they arecompared in Table 1.Conflict of interest: T.E.S. reports various types of cooperation (educa-tional, research, and consultation) with several companies marketing cardio-vascular drugs including Amgen, AstraZeneca, Merck, Orion Pharma,Pfizer, Servier. Minor stock in Orion Pharma (listed company). P.J.T. de-clares no conflict of interest related to this letter.*Corresponding author. Tel.: 1358-40-672-4533; Fax:1358-85375661.E-mail address: timo.strandberg@oulu.fi1552-5260/ 2019 the Alzheimer’s Association. Published by Elsevier Inc. All riIn the HBS, we could also relate dementia diagnosis atmedian age of 75 years to ASCVD risk factors measuredin midlife, at median age of 42 years. In adjusted analysesonly serum cholesterol was significantly related to dementiawith pure vascular or mixed features, whereas none ofmidlife ASCVD risk factors, including glucose, were relatedto pure AD during follow-up to old age [4].The data from the systematic review and HBS supportprevention possibilities in more than half of dementia cases.However, one quarter of cases seem to be because ofAlzheimer-type only dementia, which still eludes bothpreventive and curative treatments. Immune system is aprobable contributor that deserves attention [5].AcknowledgmentsThe Helsinki Businessmen Study has been supported byGustaf och Victoria Frimurarestiftelse; VTR-funding of theHelsinki University Hospital (TYH 2014245; 2015211);and the Academy of Finland (grant number 311492). Thesponsors had no role in the design or conduct of the study;collection, management, analysis, and interpretation of thedata; or preparation, review, or approval of the manuscript.Timo E. Strandberg*Clinicum and Helsinki University Hospital, University ofHelsinki, Helsinki, FinlandUniversity of Oulu, Center for Life Course Health Research,Oulu, FinlandPentti J. TienariClinicum and Helsinki University Hospital, University ofHelsinki, Helsinki, FinlandType of dementiaSystematicreview ofclinicopathologicstudiesHelsinkibusinessmenStudyAlzheimer’s disease 24 25.5Vascular dementia 26 22.5Mixed Alzheimer’sdisease plus vascular27 34.5Lewy body disease 7 3.8Other 16 13.7ghts reserved.T.E. Strandberg and P.J. Tienari / Alzheimer’s & Dementia- (2019) 1-22References[1] Azarpazhooh MR, Avan A, Cipriano LE, Munoz DG, Sposato LA,Hachinski V. Concomitant vascular and neurodegenerative pathologiesdouble the risk of dementia. Alzheimers Dement 2018;14:148–56.[2] Tanskanen M, M€akel€a M, Notkola I-L, Myllykangas L, Rastas S,Oinas M, et al. Population-based analysis of pathological correlatesof dementia in the oldest old. Ann Clin Transl Neurol 2017;4:154–65.[3] Strandberg TE, Salomaa V, Strandberg AY, Vanhanen H, Sarna S,Pitk€al€a K, et al. Cohort profile: the Helsinki Businessmen Study(HBS). Int J Epidemiol 2016;45. 1074–1074h.[4] Rantanen K, Strandberg AY, Salomaa V, Pitk€al€a K, Tilvis RS,Tienari P, et al. Cardiovascular risk factors and glucose tolerance inmidlife and risk of cognitive disorders in old age up to a 49-yearfollow-up of the Helsinki Businessmen Study. Ann Med 2017;6:462–9.[5] Steele NZ, Carr JS, BonhamLW,Geier EG, Damotte V,Miller ZA, et al.Fine-mapping of the human leukocyte antigen locus as a risk factorfor Alzheimer disease: a case-control study. PLoS Med 2017;14:e1002272.https://doi.org/10.1016/j.jalz.2019.04.004

Contributions of vascular and Alzheimer's disease pathology to dementia

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Contributions of vascular and Alzheimer's disease pathology to dementia

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