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Neuropathologic comorbidity and cognitive impairment in the Nun and Honolulu-Asia Aging Studies
White LR, Edland SD, Hemmy LS, Montine KS, Zarow C, Sonnen JA, Uyehara-Lock JH, Gelber RP et al.. Neurology, 2016-02-17
Topic: Risk, prevention and care in population studies
Objective To examine frequencies and relationships of 5 common neuropathologic abnormalities identified at autopsy with late-life cognitive impairment and dementia in 2 different autopsy panels. Methods The Nun Study (NS) and the Honolulu-Asia Aging Study (HAAS) are population-based investigations of brain aging that included repeated cognitive assessments and comprehensive brain autopsies. The neuropathologic abnormalities assessed were Alzheimer disease (AD) neuropathologic changes, neocortical Lewy bodies (LBs), hippocampal sclerosis, microinfarcts, and low brain weight. Associations with screening tests for cognitive impairment were examined. Results Neuropathologic abnormalities occurred at levels ranging from 9.7% to 43%, and were independently associated with cognitive impairment in both studies. Neocortical LBs and AD changes were more frequent among the predominantly Caucasian NS women, while microinfarcts were more common in the Japanese American HAAS men. Comorbidity was usual and very strongly associated with cognitive impairment. Apparent cognitive resilience (no cognitive impairment despite Braak stage V) was strongly associated with minimal or no comorbid abnormalities, with fewer neocortical AD lesions, and weakly with longer interval between final testing and autopsy. Conclusions Total burden of comorbid neuropathologic abnormalities, rather than any single lesion type, was the most relevant determinant of cognitive impairment in both cohorts, often despite clinical diagnosis of only AD. These findings emphasize challenges to dementia pathogenesis and intervention research and to accurate diagnoses during life.
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APA 7th
White, L. R., Edland, S. D., Hemmy, L. S., Montine, K. S., Zarow, C., Sonnen, J. A., et al. (2016). Neuropathologic comorbidity and cognitive impairment in the Nun and Honolulu-Asia Aging Studies. Neurology. https://doi.org/10.1212/wnl.0000000000002480
Vancouver
White LR, Edland SD, Hemmy LS, Montine KS, Zarow C, Sonnen JA, et al. Neuropathologic comorbidity and cognitive impairment in the Nun and Honolulu-Asia Aging Studies. Neurology. 2016. doi:10.1212/wnl.0000000000002480. PMID: 26888993.
BibTeX
@article{white2016-26888993,
author = {White, L. R. and Edland, S. D. and Hemmy, L. S. and Montine, K. S. and Zarow, C. and Sonnen, J. A. and Uyehara-Lock, J. H. and Gelber, R. P. and others},
title = {{Neuropathologic comorbidity and cognitive impairment in the Nun and Honolulu-Asia Aging Studies}},
journal = {Neurology},
year = {2016},
doi = {10.1212/wnl.0000000000002480},
pmid = {26888993},
url = {https://doi.org/10.1212/wnl.0000000000002480}
}
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Key findings
- Results Neuropathologic abnormalities occurred at levels ranging from 9.7% to 43%, and were independently associated with cognitive impairment in both studies.
- Comorbidity was usual and very strongly associated with cognitive impairment.
- Apparent cognitive resilience (no cognitive impairment despite Braak stage V) was strongly associated with minimal or no comorbid abnormalities, with fewer neocortical AD lesions, and weakly with longer interval between final testing and autopsy.
- These findings emphasize challenges to dementia pathogenesis and intervention research and to accurate diagnoses during life.
Why it matters
This autopsy study found that having more than one type of brain abnormality at once was common and was strongly linked to cognitive impairment. It suggests that the total burden of these combined abnormalities, rather than any single one, matters most for thinking problems in late life.
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Study details
- Effect size9.7%
- Evidence strengthLow
How this study scored 53/100
Published in a leading specialty journal. Scored zero for study design, sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2016 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 171 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 14.2 citations a year over 12 year(s) since 2016 |
| Impact for its field and year | 4 / 6 | Cited 16.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 18 other studies in this library |
| Still being cited | 2 / 4 | Cited 32 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Thomas Jude Montine: h-index 115 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | National Institute on Aging: institution h-index 907 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 26888993) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 53 / 100 | — |
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