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Departments of Neurology (Drs. Crystal, Fuld, Masur, Mehler, Aronson, and Wolfson, and Ms. Scott) and Pathology (Neuropathology) (Dr. Dickson) and the Rose F. Kennedy Center for Research in Mental Retardation and Human Development, Albert Einstein College of Medicine, Bronx, NY; the Department of Neurology (Dr. Masdeu), St. Vincent's Hospital, New York, NY; and the Department of Neurology (Dr. Kawas), Johns Hopkins Medical School, Baltimore, MD.
We compared neuropsychological findings in 28 longitudinally evaluated elderly subjects with their postmortem neuropathology, including senile plaque and neurofibrillary tangle counts from standardized sections. Nine of the subjects were not demented when evaluated just prior to their death. Numerous cortical senile plaques and other changes of Alzheimer's disease (AD) occurred in six of nine nondemented old-old subjects. Five of these six subjects had shown decline on yearly neuropsychological tests but their cognitive impairment was too mild to meet clinical criteria for dementia. Whereas cortical senile plaque count did not distinguish well between demented and nondemented subjects, every subject with numerous cortical neurofibrillary tangles was demented. The nondemented subjects with Alzheimer pathology may have had "preclinical" AD, or numerous cortical plaques may occur in some elderly subjects who would never develop clinical dementia.
Address correspondence and reprint requests to Dr. Crystal, Department of Neurology, Forcheimer-G9, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.
Supported in part by NIA Grants AGO 3949–05 and NS19234-05.
Received December 9, 1987. Accepted for publication in final form April 25, 1988.
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