Ecology of the aging human brain

Joshua A. Sonnen, Karen Santa Cruz, Laura S. Hemmy, Randall Woltjer, James B. Leverenz, Kathleen S. Montine, Clifford R. Jack, Jeffrey Kaye, Kelvin Lim, Eric B. Larson, Lon White, Thomas J. Montine

Research output: Contribution to journalArticlepeer-review

111 Scopus citations


Background: Alzheimer disease, cerebral vascular brain injury, and isocortical Lewy body disease (LBD) are the major contributors to dementia in community- and population-based studies. Objective: To estimate the prevalence of clinically silent forms of these diseases in cognitively normal (CN) adults. Design: Autopsy study. Setting: Community- and population based. Participants: A total of 1672 brain autopsies from the Adult Changes in Thought study, Honolulu-Asia Aging Study, Nun Study, and Oregon Brain Aging Study, of which 424 met the criteria for CN. Main Outcome Measures: Of these, 336 cases had a comprehensive neuropathologic examination of neuritic plaque density, Braak stage for neurofibrillary tangles, LB distribution, and number of cerebral microinfarcts. Results: Forty-seven percent of CN cases had moderate or frequent neuritic plaque density; of these,6% also had Braak stage V or VI for neurofibrillary tangles. Fifteen percent of CN cases had medullary LBD; 8% also had nigral and 4% isocortical LBD. The presence of any cerebral microinfarcts was identified in 33% and of high-level cerebral microinfarcts in 10% of CN individuals. Overall, the burden of lesions in each individual and their comorbidity varied widely within each study but were similar across studies. Conclusions: These data show an individually varying complex convergence of subclinical diseases in the brain of older CN adults. Appreciating this ecology should help guide future biomarker and neuroimaging studies and clinical trials that focus on community- and population-based cohorts.

Original languageEnglish (US)
Pages (from-to)1049-1056
Number of pages8
JournalArchives of neurology
Issue number8
StatePublished - Aug 2011

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology


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