Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.
Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA.
J Gerontol A Biol Sci Med Sci. 2024 Sep 1;79(9). doi: 10.1093/gerona/glae118.
Dementia results from multiple neuropathologies causing cognitive impairment sufficiently severe to affect functional status. However, these pathologies and functional impairment are common in persons without dementia. We examined the association of Alzheimer's disease (AD) and multiple other neuropathologies with instrumental and basic activities of daily living in persons with and without dementia.
Participants were 1 509 deceased from the Religious Orders Study or Rush Memory and Aging Project. Pathologic AD and 3 other AD indices were examined, in addition to 4 non-AD neurodegenerative pathologies: cerebral amyloid angiopathy (CAA), hippocampal sclerosis, TDP-43, and Lewy bodies, and 4 cerebrovascular pathologies: gross- and microinfarctions, athero- and arteriolosclerosis. Functional assessment included Lawton and Katz Index Instrumental and Basic Activities of Daily Living (IADL and BADL). Ordinal regression models adjusted for age, sex, and education were used to examine the association of neuropathologies with IADL and BADL.
Alzheimer's disease and the other neuropathologies were associated with impaired IADL (all ps < .001) and with impaired BADL (ps < .01), except for atherosclerosis and CAA, which were not associated with BADL. The effects of most neuropathologies were largely affected by dementia. However, small effects on IADL remained for PHF-tau tangles after adjusting models for dementia. Direct effects of gross infarcts on IADL and BADL and of microinfarcts on BADL remained unchanged after adjusting the models for dementia.
Alzheimer's disease and all other neuropathologies are strongly associated with functional disability. The association of most neuropathologies with disability was eliminated or attenuated by dementia, except for gross infarcts and microinfarcts.
痴呆是由多种导致认知功能严重受损的神经病理学引起的，足以影响功能状态。然而，这些病理学和功能障碍在没有痴呆的人中也很常见。我们研究了阿尔茨海默病（AD）和多种其他神经病理学与痴呆和非痴呆患者的工具性和基础性日常生活活动的关系。
参与者为来自宗教秩序研究或拉什记忆和衰老项目的 1509 名已故者。除了 4 种非 AD 神经退行性病变（脑淀粉样血管病[CAA]、海马硬化、TDP-43 和路易体）和 4 种脑血管病变（大梗死和微梗死、动脉粥样硬化和小动脉硬化）外，还检查了病理性 AD 和其他 3 种 AD 指数。功能评估包括 Lawton 和 Katz 指数工具性和基础性日常生活活动（IADL 和 BADL）。使用有序回归模型调整年龄、性别和教育因素，以研究神经病理学与 IADL 和 BADL 的关系。
AD 及其他神经病理学与 IADL 受损（所有 p 值均<0.001）和 BADL 受损（p 值均<0.01）相关，除了动脉粥样硬化和 CAA 与 BADL 无关。在调整痴呆模型后，大多数神经病理学的影响在很大程度上受到痴呆的影响。然而，在调整模型以排除痴呆的影响后，PHF-tau 缠结对 IADL 的影响以及大梗死对 IADL 和 BADL 的影响和微梗死对 BADL 的影响仍然很小。在调整痴呆模型后，大梗死对 IADL 和 BADL 的直接影响以及微梗死对 BADL 的直接影响保持不变。
AD 及所有其他神经病理学与功能障碍密切相关。除了大梗死和微梗死外，大多数神经病理学与残疾的关联在排除或减弱痴呆的影响后被消除或减弱。
