NEUROPATHOLOGY OF LATE LIFE

In the oldest age group of dementia, patients dying after age 80, 38 cases were studied clinically and neuropathologically. In comparison with dementia cases dying at younger ages the disease panorama differed in important respects. In the older age group frontal lobe dementia of non-Alzheimer type was entirely absent but trauma was much more common as were also cerebrovascular diseases. Dementia of the Alzheimer type was in many cases milder than in younger age groups and a mild, subclinical Alzheimer encephalopathy often complicated the cerebrovascular disorders. In this context. It may be of interest that some of the patients died from diseases not directly connected with the dementing disorder such as heart failure, cancer and pulmonary embolism, suggesting that the dementing disorders did not necessarily represent an end stage. Contrary to our previous opinion Alzheimer disease in these aged patients was of a very long duration, in many cases lasting 7-13 years. Labile blood pressure and orthostatism presented further prominent problems. The mild Alzheimer changes, in 1 case precluding a distinct diagnosis, may be taken as a harbinger of the vague changes found in 3 centenarians, 2 of whom had dementia. They suffered from changes of an Alzheimer encephalopathy of a subclinical severity, mild frontal white matter degeneration and a loss of frontal cortical neurons, changes that would be difficult to diagnose in life and which may be the cause of the real dementia of the senium.