Division of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
JAMA Netw Open. 2024 Jul 1;7(7):e2423377. doi: 10.1001/jamanetworkopen.2024.23377.
Race differences in dementia prevalence and incidence have previously been reported, with higher dementia burden in Black decedents. However, previous neuropathological studies were conducted mostly in convenience samples with White participants; conducting clinicopathological studies across populations is crucial for understanding the underlying dementia causes in individuals from different racial backgrounds.
To compare the frequencies of neuropathological lesions and cognitive abilities between Black and White Brazilian adults in an autopsy study.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used samples from the Biobank for Aging Studies, a population-based autopsy study conducted in Sao Paulo, Brazil. Participants were older adults whose family members consented to the brain donations; Asian participants and those with missing data were excluded. Samples were collected from 2004 to 2023. Neuropathologists were masked to cognitive outcomes.
Race as reported by the deceased's family member.
The frequencies of neurodegenerative and cerebrovascular lesions were evaluated in 13 selected cerebral areas. Cognitive and functional abilities were examined with the Clinical Dementia Rating Scale.
The mean (SD) age of the 1815 participants was 74.0 (12.5) years, 903 (50%) were women, 617 (34%) were Black, and 637 (35%) had cognitive impairment. Small vessel disease (SVD) and siderocalcinosis were more frequent in Black compared with White participants (SVD: odds ratio [OR], 1.74; 95% CI, 1.29-2.35; P < .001; siderocalcinosis: OR, 1.70; 95% CI, 1.23-2.34; P = .001), while neuritic plaques were more frequent in White compared with Black participants (OR, 0.61; 95% CI, 0.44-0.83; P = .002). Likewise, Alzheimer disease neuropathological diagnosis was more frequent in White participants than Black participants (198 [39%] vs 77 [33%]), while vascular dementia was more common among Black participants than White participants (76 [32%] vs 121 [24%]). Race was not associated with cognitive abilities, nor did it modify the association between neuropathology and cognition.
In this cross-sectional study of Brazilian older adults, Alzheimer disease pathology was more frequent in White participants while vascular pathology was more frequent in Black participants. Further neuropathological studies in diverse samples are needed to understand race disparities in dementia burden.
先前已有研究报告指出，痴呆症的患病率和发病率在不同种族之间存在差异，黑种人死亡者的痴呆症负担更高。然而，先前的神经病理学研究主要是在有白人参与者的便利样本中进行的；在不同人群中进行临床病理研究对于理解不同种族背景个体的潜在痴呆症原因至关重要。
在一项尸检研究中比较黑人和白人巴西成年人的神经病理学病变和认知能力频率。
设计、地点和参与者：本横断面研究使用了巴西圣保罗的基于人群的尸检研究生物银行的样本。参与者是其家属同意捐献大脑的老年人；排除了亚洲参与者和数据缺失者。样本采集于 2004 年至 2023 年。神经病理学家对认知结果进行了设盲。
由死者家属报告的种族。
在 13 个选定的大脑区域评估了神经退行性和脑血管病变的频率。使用临床痴呆评定量表评估认知和功能能力。
1815 名参与者的平均（标准差）年龄为 74.0（12.5）岁，903 名（50%）为女性，617 名（34%）为黑人，637 名（35%）存在认知障碍。与白人参与者相比，黑人参与者的小血管疾病（SVD）和铁钙蛋白沉着症更为常见（SVD：比值比[OR]，1.74；95%置信区间[CI]，1.29-2.35；P<.001；铁钙蛋白沉着症：OR，1.70；95%CI，1.23-2.34；P=.001），而白人参与者的神经原纤维缠结比黑人参与者更为常见（OR，0.61；95%CI，0.44-0.83；P=.002）。同样，白人参与者的阿尔茨海默病病理诊断比黑人参与者更为常见（198 例[39%]比 77 例[33%]），而黑人参与者的血管性痴呆比白人参与者更为常见（76 例[32%]比 121 例[24%]）。种族与认知能力无关，也未改变神经病理学与认知之间的关联。
在这项对巴西老年人的横断面研究中，白人参与者的阿尔茨海默病病理更为常见，而黑人参与者的血管病理更为常见。需要在不同样本中进行更多的神经病理学研究，以了解痴呆症负担方面的种族差异。
