[P3.213] Normal Cognition in a 99-year-old Man with High Levels of Alzheimer Disease Pathology

Kristoffer Nissinen,1Barbara Agee Shah,2Maria Corrada,3Ronald C. Kim,4Szofia Bullain,5Claudia Kawas5
1Orange, CA, USA, 2USA, 3Irivine, CA, USA, 4Long Beach, CA, USA, 5Irvine, CA, USA

OBJECTIVE:To present a case report of a 99 year-old man with normal cognition despite high Alzheimer Disease (AD) pathology
BACKGROUND:High levels of AD pathology are usually associated with cognitive impairment and are not expected in people with normal cognition. However, the oldest-old (>90 years old) may represent a unique population where intact cognition may be possible despite high burden of plaques and tangles.
DESIGN/METHODS:A 94yo man with no cognitive impairment was evaluated with neuropsychiatric testing over 5 years with biannual visits until death at age 99. Cognitive function was evaluated with the Modified Mini-Mental State Test (3MS), Trail Making Test parts A and B (TMT-A and B), California Verbal Learning Test (CVLT) and Boston Naming Test (BNT). ApoE genetic testing was obtained. Post-mortem histological grading and diagnosis was performed using the Braak & Braak staging.
RESULTS:On all visits, most scores ranged in the 75th-95th percentile (3MS, CVLT, TMT-A and BNT) when compared to age-specific norms. Although some fluctuations were noted, there was no obvious decline. TMT-B showed the most fluctuations, with completion times between 95-253 seconds and 0-3 errors per trial, but scores remained in the 50th to 95th percentile without decline. Post-mortem evaluation showed tangle stage V and plaque stage C, consistent with high levels of AD pathology. ApoE genetic testing revealed a 2/3 genotype.
CONCLUSIONS:Our case suggests that the oldest-old may be able to withstand high levels of AD pathology without cognitive impairment. Although ApoE 2/3 genotype may provide protection, there may be other mechanisms associated with preserved cognition. It may also be possible that our participant was in the preclinical stages of the disease and current neuropsychological tests lack sensitivity to detect very subtle cognitive changes. Further investigation is needed to reveal what other factors may provide protection from late age cognitive decline.
Study Supported by:
Category - Aging, Dementia, and Cognitive and Behavioral Neurology: Cognitive Aging/Dementia/Memory

Tuesday, April 29, 2014 3:00 PM

P3: Poster Session III: Aging, Dementia, and Cognitive and Behavioral Neurology: Clinical Aspects (3:00 PM-6:30 PM)


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